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Edit Comment Close Premium member Presentation Transcript Domestic violence : Domestic violence Taylor College Domestic Violence : Domestic Violence Violence can involve: Psychological Economic Emotional Physical Sexual Abuse It can happen to: Children Adolescents Adults Disabled Elderly Your patients Family members Friends Children Yourself Incidence and Prevalence : Incidence and Prevalence It has been estimated that 2 to 4 million women are battered each year in the United States. 90 – 95% of domestic violence victims are women Over half of all women will be physically abused at least once during their lifetime Violence between family members and acquaintances accounts for more than half of all homicides Physical violence occurs in 20-35% of dating relationships; 12% of teens and over 20% of college students report dating violence A study conducted in a prenatal setting found that the rate of abuse during pregnancy was 21.7% for teens and 15.9% for adult women Child abuse occurs in 30-60% of family violence cases that involve families with children Dynamics of Domestic Violence : Dynamics of Domestic Violence Understanding the dynamics of domestic violence is a prerequisite to understanding the situation in which the patient finds themselves. The New York State office for the Prevention of Domestic Violence has defined domestic abuse in 5 categories. Physical Abuse Sexual Abuse Psychological Abuse Emotional Abuse Economic Abuse Physical Abuse : Physical Abuse Inflicting or attempting to inflict physical injury and/or illness. Examples: Grabbing, pinching, shoving, slapping, hitting, hair-pulling, biting, arm-twisting, kicking, punching, hitting with blunt objects, stabbing, shooting Withholding access to resources necessary to maintain health. Examples: Medication, medical care, wheelchair, food or fluids, sleep or hygienic assistance Forcing alcohol or drug use. Sexual Abuse : Sexual Abuse Coercing or attempting to coerce any sexual contact without consent. Examples: marital rape, acquaintance rape, forced sex after physical beating, attacks on the sexual part of the body, bestiality, forced prostitution, unprotected sex, fondling, sodomy, sex with others, use pornography Attempting to undermine the victim’s sexuality. Treating her or him in a sexually derogatory manner, criticizing sexual performance and desirability, accusations of infidelity, withholding sex Psychological Abuse : Psychological Abuse Instilling or attempting to instill fear Examples: intimidation, threatening physical harm to self, victim and/or others, threatening to harm and/or kidnap children, menacing, blackmail, harassment, destruction of pets and property, mind games Isolating or attempting to isolate victim from friends, family, school and/or work Examples: withholding access to phone and/or transportation, undermining victim’s personal relationships, harassing others, use of unfound accusations, forced imprisonment Emotional Abuse : Emotional Abuse Undermining or attempting to undermine victim’s sense of self worth Examples: constant criticism, belittling victim’s abilities and competency, name calling, insults, putdowns, silent treatment, manipulating victim’s feelings and emotions to induce guilt, repeatedly making and breaking promises Economic Abuse : Economic Abuse Making or attempting to make the victim financially dependent Examples: Maintaining total control over financial resources including victim’s earned income, withholding money and/or access of money, forbidding attendance at school, forbidding employment, on-the-job harassment, requiring accountability and justification for all money spent, forced welfare fraud, withholding information about family finances Cycle of Violence : Cycle of Violence In 1979, Leonore Walker wrote The Battered Women and proposed a “Cycle of Violence” which has 3 phases. Tension Build-Up: May involve arguing or silent treatment. This can last for days, years or indefinitely. Physical Violence: Also can last a few seconds, days or years. Violence may stop for a variety of reasons such as: victim leaves, police are called, abusers realize what is wrong or medical attention is needed. Relative calm: This period may have the appearance of reconciliation or respite. Batterer may apologize, beg for forgiveness or promise that it will never happen again. The victim usually forgives and the cycle is repeated. Power & Control Wheel : Power & Control Wheel The Power and Control Wheel presents another perspective in viewing the dynamics of domestic violence. Underscores the ongoing behaviors of the batterer as she/he attempts to maintain power & control over all aspects of the victim’s life. Instead of being cyclical, the violence is unrelenting. Using coercion and threats Intimidation Emotional abuse Isolation Minimizing Denying and blaming Using children Using male privilege Economic abuse Victims of Domestic Violence : Victims of Domestic Violence Florida statue 741.28 states, “Domestic violence means any assault, aggravated assault, battery, aggravated battery, stalking, aggravated stalking, or any criminal offence resulting in physical injury or death of one family or household member by another who is or was residing in the same single dwelling unit.” Victims of domestic violence include “family or household members.” Defined as “spouse, person related by blood or marriage, persons who are presently residing together as if a family or who have resided together in the past as if family and persons who have a child in common regardless of whether they have been married or have resided together at any time.” Victims of Domestic Violence : Victims of Domestic Violence Anyone can be a victim. There is no profile and no easy criteria for determining who will be a victim of domestic violence. It is not possible to recognize victims based on demographic factors such as socioeconomic status, race or ethnicity. The majority of victims reported domestic violence incidents are women from all age groups, ethnicity and backgrounds. Men can also be victims of domestic violence. Victims of Domestic Violence : Victims of Domestic Violence In the health care setting, victims of domestic violence are most often identified by the injuries, signs and symptoms for which they seek treatment. Acute signs and symptoms sustained by victims of domestic violence may include: Bruises Lacerations Concussions Fractures Chronic signs and symptoms include: Joint damage Partial loss of hearing or vision Scars from burns Bites or knife wounds Victims of Domestic Violence : Victims of Domestic Violence Pregnant women are often seen with injuries to the breasts, abdomen and face and may exhibit unexplained vaginal bleeding, placental separation or preterm labor. The impact of this abuse extends to the unborn child. Battering during pregnancy has been associated with the increased incidence of spontaneous abortion, stillbirth and delivery of low birth weight infants. Pregnant women who are abused are more likely to delay seeking prenatal care until the third trimester. Victims of Domestic Violence : Victims of Domestic Violence Domestic violence can also effect the long-term psychological and social well being of its victims. Specifically, victims of domestic abuse often experience: Isolation Fatigue Anxiety Sleeping disturbances Eating disorders Hopelessness Vulnerability Sense of loss Psychological and social Effects of Domestic Violence : Psychological and social Effects of Domestic Violence Victims do not readily reveal their situation or leave it. There are many reasons for this, including the following: Fear of humiliation about being abused Fear of being judged and losing the respect of others Fear of losing economic support if the batterer is jailed Belief that the relationship or marriage is for better or worse Becoming desensitized to the severity of their situation Belief that the violence was his/her fault Lack of support from friends and family as a result of the isolation Guilt about breaking up their family Fear of physical, emotional or legal retribution if the abuser finds out that the victim told someone or tried to leave Belief that the victim can control the violence by changing his/her behavior or circumstances Leaving does not solve everything. One third of the victims were not living with their batterer at the time of the incidence. Violence often escalates when the victim leaves or tries to leave. Perpetrators of Domestic Violence : Perpetrators of Domestic Violence It is not possible to predict who will be a batterer based on a single personality profile. Batterers who accompany victims in need of medical care may seem overly concerned, protective or possessive. They may seem enraged or lashing out at staff or they may not accompany the victim at all. Some behavior, psychological and family factors that may be indicators of the need for further investigation include: Lack of communication skills Difficulty in negotiating interpersonal conflict Minimization or denial of domestic disputes or violent behavior History of alcohol and/or drug abuse Family history of violence Frequent verbal arguments with spouse Controlling behavior. Effects of Domestic Violence on Children, Families and Society : Effects of Domestic Violence on Children, Families and Society Between 50-70% of husbands who batter their wives also batter their children. Children who witness domestic violence may present clinically with a variety of cognitive, emotional and behavioral responses such as school problems, poor peer relation, anxiety, sleeping problems and other stress related symptoms. Effective interventions for children demonstrating behavioral and emotional problems related to domestic violence include: Support groups Education in anger control Social problems solving How to get along with peers Empathy skills These strategies help children heal and learn new coping skills for avoiding violence in the future. The Role of Health and Mental Health Providers : The Role of Health and Mental Health Providers Distinctions in professional roles dictate different levels of involvement in domestic violence. It is the responsibility of professionals to educate and increase public awareness of detection, intervention and prevention of domestic violence. Responsibilities for all professionals include identifying the physical signs, symptoms and behavioral indicators of domestic violence and also becoming familiar with institutional policies and state laws. The Role of Health and Mental Health Providers : The Role of Health and Mental Health Providers Many professionals have concerns regarding legal and risk management issues related to domestic violence. Risk management departments must be notified through an incident report. Risk management may also serve as an important resource for information and advice. Hospital policies and procedures generally explain relevant aspects of the law as well as interpret their use in a particular setting. Recognizing and Overcoming Provider Barriers : Recognizing and Overcoming Provider Barriers In addressing domestic violence, it is often helpful for care givers to explore their own feelings, perceptions and attitudes. Barriers that may affect the professional’s ability to identify domestic violence could include the following: Fear for their own safety from the batterer Identification with the victim or batterer Lack of awareness of the problem Belief that it is not the health care provider’s role Belief that domestic violence is a “private matter” Continuum of Care and Intervention : Continuum of Care and Intervention The continuum begins with screening for all patients, regardless of whether or not domestic violence is suspected, followed by assessment of the patients for whom there is an index of suspicion and intervention when domestic violence is confirmed. Screening Patients for Domestic Violence : Screening Patients for Domestic Violence Domestic violence is so prevalent that all patients should be screened regardless of the reason for seeking health care and whether or not domestic violence is suspected. Screening should be conducted in emergency rooms, inpatient and outpatient settings and during home health visits. Screening is best accomplished through an open, objective and empathic approach. It should occur individually and in a private, confidential manner. Screening Patients for Domestic Violence : Screening Patients for Domestic Violence Begin by asking nonthreatening questions, followed by more specific questions based on the index of suspicion, the setting and situation. Being attuned to the patient’s level of comfort and anxiety is the key to effective screening. Ask questions related to: Financial difficulties Unemployment Poor family communication skills Conflict management skills Poor coping mechanisms Weak support system A history of family abuse Provide an opportunity for the batterer to express his/her feelings. The professional can then validate the feelings while objecting to the behavior. It must be made clear that the behavior is the batters choice and it is the batterers responsibility to change Screening Patients for Domestic Violence : Screening Patients for Domestic Violence Treatment for the batterer follows similar strategies. Court mandated counseling programs for the batters focus on the battering behavior. Batterers learn that it is imperative for all violence to stop. In addition they are taught: Anger management Gender differences in communication Negative consequences of violence Negative effects of their behavior on their children Assessment of Suspected Victims : Assessment of Suspected Victims Patient assessment is conducted when there is suspicion of domestic violence. In addition to treating the injuries a comprehensive assessment includes: Interviewing the patient Performing a physical exam Documenting the information gathered Building a trusting relationship with the patient is vital. The attitude and behavior of the provider are the key to the process. Assessment of Suspected Victims : Assessment of Suspected Victims The following questions are examples to assist the professional in screening for risk: What’s creating stress in your life these days? How would you describe your relationship? What happens when you or your partner gets angry or if you have a fight? Does your partner make you feel bad about yourself? Do you sometimes feel like you’re walking on egg shells? Tell me about it or describe what it is like. In what ways do you want me to help you? What else would you like to tell me? Adding routine questions to intake forms and other established methods of information gathering helps the patient and the professional gently open the door to discussing domestic violence. Not all victims will disclose this information. Asking questions may plant the seed that will lead to further discussion. Sometimes numerous encounters with the victim are needed before she/he is ready to acknowledge the situation. Identifying Suspected Batterers : Identifying Suspected Batterers Batters can be identified with screening tools. When suspected batterers are identified, it is important to remain objective and non-judgmental. Provide an opportunity for the batterer to express feelings. Validate feelings, while objecting to the behavior. Point out negative consequences of the behaviors and the hope for a better relationship. Provide resources for treatment. Assure batterer that you will continue to be the healthcare provider. Interviewing the Patients : Interviewing the Patients Interview the patient alone and away from the batterer. Batterers often appear as hovering, overly attentive and concerned. If the batterer is present, they may intimidate the victim and prevent him/her from disclosing the cause of the injuries. Ask the suspected batterer to leave the room during the interview and physical exam. Be creative. If necessary, utilize the institution’s visitor policy or ask a colleague for assistance. Maintaining the safety and confidentiality of the suspected victim is a priority. If a restraining order or other legal protection has been obtained by the victim and the victim believes the batterer will come to the hospital, the staff should be informed and given a description of the batterer. Follow institutional policy and state laws when interacting with the batterer. Interviewing the Patients : Interviewing the Patients The following questions can be used to uncover violence, evaluate the extent of the violence and determine safety issues when interviewing patients about their situation: Did someone cause these injuries? Who? Has it happened before? Tell me how this happened to you. You have mentioned your spouse/partner loses his/her temper easily. How are things between you? Did your spouse/partner do this to you? What do you fear most? Interviewing the Patients : Interviewing the Patients Questions to Evaluate the Extent of Violence How many times during your relationship have you had physical fights? Have you ever been hit, punched, kicked or hurt in any way before? Are you afraid it will happen again? Were you afraid to come here today? Have there been previous episodes? About how many? For how long a time? Questions to Determine Safety Are you afraid to go home at night? Are you living together now? If living together now, have you ever left home? When? What happened? Have you wished you could leave? What has prevented it? Are there a children at home? Do you feel they are in danger? Has she/he ever been abusive towards them? If so was a police report filed? Do you have a safe way to get home from here and a safe place to stay? A victim of domestic abuse will attribute the injuries to being clumsy or accident prone. They may be anxious and evasive during the interview and not make eye contact. Documenting Domestic Violence : Documenting Domestic Violence Suggested guidelines regarding documentation of domestic violence include the following: Be specific and objective when describing the signs and symptoms of injuries. Record the patient’s description of how the injury happened, using the patient’s own words. Direct quotes should be used and prefaced with “the patient states...” Document injuries for which the patient is seeking care and include other injuries in various states of healing. Describe size, location and age of injuries using a body map. The time of injury can be estimated from the color of the bruises. Include your opinion on whether the patient’s explanation is consistent with the injury. Documenting Domestic Violence : Documenting Domestic Violence Take photographs after obtaining the patient’s consent. Take photos from different angles, including the patient’s face. Label with the date and name of patient. Document on the back of each photograph the patient’s name. Record the amount of the patient’s distress as a finding. Note the interaction of the patient and possible patient abuser. Document any Health and Rehabilitation Services contacted. Notify the risk management in your institution. Collect forensic evidence in accordance with institutional policy and state laws. Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Once domestic violence has been uncovered and assessed, intervening in the situation is next steps. Victims, whether or not they are deciding to leave the abusive relationship, often require a variety of health, mental health, legal and social services. These can include: Healthcare services Shelter Financial Assistance Law enforcement involvement Legal service in order to obtain an injunctions Food stamps Other assistance Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Reporting Domestic Violence: It is important to tell the victim about his/her right to report the abuse. However the victim is not obligated to do so and cannot be forced or coerced into reporting. Professionals in the State of Florida are required to report child or elder abuse. Mandatory reporting of domestic violence is required only if the person is suffering from an injury inflicted by a weapon. Any legal intervention must be done with the victim’s knowledge and consent. Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Providing Information and Making Referrals: Issues of safety must be considered. If the batterer is present during the visit, employ strategies to ensure privacy. Written information, pamphlets, brochures, domestic violence hot-line numbers and addresses of shelters can place a victim at further risk if found by the batterer. Ask the patient if it is safe to take the information. Warn the patient to put any written information in a safe place where the abuser cannot find it. Assess for immediate need for shelter or crisis counseling. The victim may want to consider staying with a family member or friend. She/he should choose a location where the batterer is not likely to find them. Give information and telephone numbers of the community resources and legal options. Plan a follow-up appointment within a week and obtain the patient’s permission before making referrals or sharing information with other professionals. Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Filing an Injunction: Injunctions are available for victims of domestic violence to protect themselves and their children from abusers. Temporary injunctions can be obtained 24 hours a day, seven days a week. Judges will grant a temporary injunction based on a sworn petition filed with the clerk of the court. Neither evidence nor an attorney are required to file for a temporary injunction. It is important that the victim attend all hearings so that she/he can explain his/her needs to the judge. Within 15 days, a hearing will be held for a permanent injunction that may be granted for one year. The injunction will mandate that the victim has temporary custody of any children she/he and the abuser have together. Once an injunction has been filed, the victim becomes eligible through the court system for additional services including temporary child support, food stamps, and counseling for the victim and children. Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Strategies for getting an effective police response include the following: Remain as calm as possible Ask the police to file a report Describe the assault in detail Show all injuries, bruises or damaged property Identify witnesses to the incident Describe other violent incidents Show any court documents you have (IE: restraining orders) Ask for community resources such as shelters, hotline, counseling and advocacy Ask for the case number of the report and a phone number if you want to follow up on the case Safety Plan : Safety Plan Before the violent incident: Be aware of escalating behavior Remove weapons from the house Ask a neighbor to call the police if they hear suspicious noises coming from your home Teach your children how to call the police (911), escape routes from the house and when to leave Plan where you would go in an emergency, somewhere your partner will not know to look for you Make a plan on how to leave Gather and hide items you need to make an escape such as money, keys, clothing, important documents, important phone numbers, valued personal items Safety Plan : Safety Plan After the violent incident: Check yourself and children for injuries, go to the hospital in necessary If you left your children behind, go to the police as soon as possible to get them checked in File a report with the police and consider an injunction. Remember the court order does not guarantee File a report with the police and consider an injunction. Remember the court order does not guarantee your safety. Live your safety plan. Seek help from a counselor or shelter to help you understand why this happened and how to prevent it. It may be the best gift you give yourself. Preventing Domestic Violence : Preventing Domestic Violence One message or method will not reach everyone. Consideration must be given to factors such as content, literacy, language preference, location of materials and cultural diversity. Include options and resources available in the community. As stated before,, sometimes you just planted the seed that domestic violence is not normal, not deserved and not acceptable. It may be the beginning of the end of domestic violence in a person’s life. You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Domestic Violence Davehoy Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1235 Category: Education License: All Rights Reserved Like it (2) Dislike it (0) Added: April 23, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: moennalal (14 month(s) ago) i have a presentation of domestic violence and i like to have this presentation please. Saving..... Post Reply Close Saving..... Edit Comment Close By: R.Zwan (22 month(s) ago) This si the best presentation for the topic and i really need this fr the viva. Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Domestic violence : Domestic violence Taylor College Domestic Violence : Domestic Violence Violence can involve: Psychological Economic Emotional Physical Sexual Abuse It can happen to: Children Adolescents Adults Disabled Elderly Your patients Family members Friends Children Yourself Incidence and Prevalence : Incidence and Prevalence It has been estimated that 2 to 4 million women are battered each year in the United States. 90 – 95% of domestic violence victims are women Over half of all women will be physically abused at least once during their lifetime Violence between family members and acquaintances accounts for more than half of all homicides Physical violence occurs in 20-35% of dating relationships; 12% of teens and over 20% of college students report dating violence A study conducted in a prenatal setting found that the rate of abuse during pregnancy was 21.7% for teens and 15.9% for adult women Child abuse occurs in 30-60% of family violence cases that involve families with children Dynamics of Domestic Violence : Dynamics of Domestic Violence Understanding the dynamics of domestic violence is a prerequisite to understanding the situation in which the patient finds themselves. The New York State office for the Prevention of Domestic Violence has defined domestic abuse in 5 categories. Physical Abuse Sexual Abuse Psychological Abuse Emotional Abuse Economic Abuse Physical Abuse : Physical Abuse Inflicting or attempting to inflict physical injury and/or illness. Examples: Grabbing, pinching, shoving, slapping, hitting, hair-pulling, biting, arm-twisting, kicking, punching, hitting with blunt objects, stabbing, shooting Withholding access to resources necessary to maintain health. Examples: Medication, medical care, wheelchair, food or fluids, sleep or hygienic assistance Forcing alcohol or drug use. Sexual Abuse : Sexual Abuse Coercing or attempting to coerce any sexual contact without consent. Examples: marital rape, acquaintance rape, forced sex after physical beating, attacks on the sexual part of the body, bestiality, forced prostitution, unprotected sex, fondling, sodomy, sex with others, use pornography Attempting to undermine the victim’s sexuality. Treating her or him in a sexually derogatory manner, criticizing sexual performance and desirability, accusations of infidelity, withholding sex Psychological Abuse : Psychological Abuse Instilling or attempting to instill fear Examples: intimidation, threatening physical harm to self, victim and/or others, threatening to harm and/or kidnap children, menacing, blackmail, harassment, destruction of pets and property, mind games Isolating or attempting to isolate victim from friends, family, school and/or work Examples: withholding access to phone and/or transportation, undermining victim’s personal relationships, harassing others, use of unfound accusations, forced imprisonment Emotional Abuse : Emotional Abuse Undermining or attempting to undermine victim’s sense of self worth Examples: constant criticism, belittling victim’s abilities and competency, name calling, insults, putdowns, silent treatment, manipulating victim’s feelings and emotions to induce guilt, repeatedly making and breaking promises Economic Abuse : Economic Abuse Making or attempting to make the victim financially dependent Examples: Maintaining total control over financial resources including victim’s earned income, withholding money and/or access of money, forbidding attendance at school, forbidding employment, on-the-job harassment, requiring accountability and justification for all money spent, forced welfare fraud, withholding information about family finances Cycle of Violence : Cycle of Violence In 1979, Leonore Walker wrote The Battered Women and proposed a “Cycle of Violence” which has 3 phases. Tension Build-Up: May involve arguing or silent treatment. This can last for days, years or indefinitely. Physical Violence: Also can last a few seconds, days or years. Violence may stop for a variety of reasons such as: victim leaves, police are called, abusers realize what is wrong or medical attention is needed. Relative calm: This period may have the appearance of reconciliation or respite. Batterer may apologize, beg for forgiveness or promise that it will never happen again. The victim usually forgives and the cycle is repeated. Power & Control Wheel : Power & Control Wheel The Power and Control Wheel presents another perspective in viewing the dynamics of domestic violence. Underscores the ongoing behaviors of the batterer as she/he attempts to maintain power & control over all aspects of the victim’s life. Instead of being cyclical, the violence is unrelenting. Using coercion and threats Intimidation Emotional abuse Isolation Minimizing Denying and blaming Using children Using male privilege Economic abuse Victims of Domestic Violence : Victims of Domestic Violence Florida statue 741.28 states, “Domestic violence means any assault, aggravated assault, battery, aggravated battery, stalking, aggravated stalking, or any criminal offence resulting in physical injury or death of one family or household member by another who is or was residing in the same single dwelling unit.” Victims of domestic violence include “family or household members.” Defined as “spouse, person related by blood or marriage, persons who are presently residing together as if a family or who have resided together in the past as if family and persons who have a child in common regardless of whether they have been married or have resided together at any time.” Victims of Domestic Violence : Victims of Domestic Violence Anyone can be a victim. There is no profile and no easy criteria for determining who will be a victim of domestic violence. It is not possible to recognize victims based on demographic factors such as socioeconomic status, race or ethnicity. The majority of victims reported domestic violence incidents are women from all age groups, ethnicity and backgrounds. Men can also be victims of domestic violence. Victims of Domestic Violence : Victims of Domestic Violence In the health care setting, victims of domestic violence are most often identified by the injuries, signs and symptoms for which they seek treatment. Acute signs and symptoms sustained by victims of domestic violence may include: Bruises Lacerations Concussions Fractures Chronic signs and symptoms include: Joint damage Partial loss of hearing or vision Scars from burns Bites or knife wounds Victims of Domestic Violence : Victims of Domestic Violence Pregnant women are often seen with injuries to the breasts, abdomen and face and may exhibit unexplained vaginal bleeding, placental separation or preterm labor. The impact of this abuse extends to the unborn child. Battering during pregnancy has been associated with the increased incidence of spontaneous abortion, stillbirth and delivery of low birth weight infants. Pregnant women who are abused are more likely to delay seeking prenatal care until the third trimester. Victims of Domestic Violence : Victims of Domestic Violence Domestic violence can also effect the long-term psychological and social well being of its victims. Specifically, victims of domestic abuse often experience: Isolation Fatigue Anxiety Sleeping disturbances Eating disorders Hopelessness Vulnerability Sense of loss Psychological and social Effects of Domestic Violence : Psychological and social Effects of Domestic Violence Victims do not readily reveal their situation or leave it. There are many reasons for this, including the following: Fear of humiliation about being abused Fear of being judged and losing the respect of others Fear of losing economic support if the batterer is jailed Belief that the relationship or marriage is for better or worse Becoming desensitized to the severity of their situation Belief that the violence was his/her fault Lack of support from friends and family as a result of the isolation Guilt about breaking up their family Fear of physical, emotional or legal retribution if the abuser finds out that the victim told someone or tried to leave Belief that the victim can control the violence by changing his/her behavior or circumstances Leaving does not solve everything. One third of the victims were not living with their batterer at the time of the incidence. Violence often escalates when the victim leaves or tries to leave. Perpetrators of Domestic Violence : Perpetrators of Domestic Violence It is not possible to predict who will be a batterer based on a single personality profile. Batterers who accompany victims in need of medical care may seem overly concerned, protective or possessive. They may seem enraged or lashing out at staff or they may not accompany the victim at all. Some behavior, psychological and family factors that may be indicators of the need for further investigation include: Lack of communication skills Difficulty in negotiating interpersonal conflict Minimization or denial of domestic disputes or violent behavior History of alcohol and/or drug abuse Family history of violence Frequent verbal arguments with spouse Controlling behavior. Effects of Domestic Violence on Children, Families and Society : Effects of Domestic Violence on Children, Families and Society Between 50-70% of husbands who batter their wives also batter their children. Children who witness domestic violence may present clinically with a variety of cognitive, emotional and behavioral responses such as school problems, poor peer relation, anxiety, sleeping problems and other stress related symptoms. Effective interventions for children demonstrating behavioral and emotional problems related to domestic violence include: Support groups Education in anger control Social problems solving How to get along with peers Empathy skills These strategies help children heal and learn new coping skills for avoiding violence in the future. The Role of Health and Mental Health Providers : The Role of Health and Mental Health Providers Distinctions in professional roles dictate different levels of involvement in domestic violence. It is the responsibility of professionals to educate and increase public awareness of detection, intervention and prevention of domestic violence. Responsibilities for all professionals include identifying the physical signs, symptoms and behavioral indicators of domestic violence and also becoming familiar with institutional policies and state laws. The Role of Health and Mental Health Providers : The Role of Health and Mental Health Providers Many professionals have concerns regarding legal and risk management issues related to domestic violence. Risk management departments must be notified through an incident report. Risk management may also serve as an important resource for information and advice. Hospital policies and procedures generally explain relevant aspects of the law as well as interpret their use in a particular setting. Recognizing and Overcoming Provider Barriers : Recognizing and Overcoming Provider Barriers In addressing domestic violence, it is often helpful for care givers to explore their own feelings, perceptions and attitudes. Barriers that may affect the professional’s ability to identify domestic violence could include the following: Fear for their own safety from the batterer Identification with the victim or batterer Lack of awareness of the problem Belief that it is not the health care provider’s role Belief that domestic violence is a “private matter” Continuum of Care and Intervention : Continuum of Care and Intervention The continuum begins with screening for all patients, regardless of whether or not domestic violence is suspected, followed by assessment of the patients for whom there is an index of suspicion and intervention when domestic violence is confirmed. Screening Patients for Domestic Violence : Screening Patients for Domestic Violence Domestic violence is so prevalent that all patients should be screened regardless of the reason for seeking health care and whether or not domestic violence is suspected. Screening should be conducted in emergency rooms, inpatient and outpatient settings and during home health visits. Screening is best accomplished through an open, objective and empathic approach. It should occur individually and in a private, confidential manner. Screening Patients for Domestic Violence : Screening Patients for Domestic Violence Begin by asking nonthreatening questions, followed by more specific questions based on the index of suspicion, the setting and situation. Being attuned to the patient’s level of comfort and anxiety is the key to effective screening. Ask questions related to: Financial difficulties Unemployment Poor family communication skills Conflict management skills Poor coping mechanisms Weak support system A history of family abuse Provide an opportunity for the batterer to express his/her feelings. The professional can then validate the feelings while objecting to the behavior. It must be made clear that the behavior is the batters choice and it is the batterers responsibility to change Screening Patients for Domestic Violence : Screening Patients for Domestic Violence Treatment for the batterer follows similar strategies. Court mandated counseling programs for the batters focus on the battering behavior. Batterers learn that it is imperative for all violence to stop. In addition they are taught: Anger management Gender differences in communication Negative consequences of violence Negative effects of their behavior on their children Assessment of Suspected Victims : Assessment of Suspected Victims Patient assessment is conducted when there is suspicion of domestic violence. In addition to treating the injuries a comprehensive assessment includes: Interviewing the patient Performing a physical exam Documenting the information gathered Building a trusting relationship with the patient is vital. The attitude and behavior of the provider are the key to the process. Assessment of Suspected Victims : Assessment of Suspected Victims The following questions are examples to assist the professional in screening for risk: What’s creating stress in your life these days? How would you describe your relationship? What happens when you or your partner gets angry or if you have a fight? Does your partner make you feel bad about yourself? Do you sometimes feel like you’re walking on egg shells? Tell me about it or describe what it is like. In what ways do you want me to help you? What else would you like to tell me? Adding routine questions to intake forms and other established methods of information gathering helps the patient and the professional gently open the door to discussing domestic violence. Not all victims will disclose this information. Asking questions may plant the seed that will lead to further discussion. Sometimes numerous encounters with the victim are needed before she/he is ready to acknowledge the situation. Identifying Suspected Batterers : Identifying Suspected Batterers Batters can be identified with screening tools. When suspected batterers are identified, it is important to remain objective and non-judgmental. Provide an opportunity for the batterer to express feelings. Validate feelings, while objecting to the behavior. Point out negative consequences of the behaviors and the hope for a better relationship. Provide resources for treatment. Assure batterer that you will continue to be the healthcare provider. Interviewing the Patients : Interviewing the Patients Interview the patient alone and away from the batterer. Batterers often appear as hovering, overly attentive and concerned. If the batterer is present, they may intimidate the victim and prevent him/her from disclosing the cause of the injuries. Ask the suspected batterer to leave the room during the interview and physical exam. Be creative. If necessary, utilize the institution’s visitor policy or ask a colleague for assistance. Maintaining the safety and confidentiality of the suspected victim is a priority. If a restraining order or other legal protection has been obtained by the victim and the victim believes the batterer will come to the hospital, the staff should be informed and given a description of the batterer. Follow institutional policy and state laws when interacting with the batterer. Interviewing the Patients : Interviewing the Patients The following questions can be used to uncover violence, evaluate the extent of the violence and determine safety issues when interviewing patients about their situation: Did someone cause these injuries? Who? Has it happened before? Tell me how this happened to you. You have mentioned your spouse/partner loses his/her temper easily. How are things between you? Did your spouse/partner do this to you? What do you fear most? Interviewing the Patients : Interviewing the Patients Questions to Evaluate the Extent of Violence How many times during your relationship have you had physical fights? Have you ever been hit, punched, kicked or hurt in any way before? Are you afraid it will happen again? Were you afraid to come here today? Have there been previous episodes? About how many? For how long a time? Questions to Determine Safety Are you afraid to go home at night? Are you living together now? If living together now, have you ever left home? When? What happened? Have you wished you could leave? What has prevented it? Are there a children at home? Do you feel they are in danger? Has she/he ever been abusive towards them? If so was a police report filed? Do you have a safe way to get home from here and a safe place to stay? A victim of domestic abuse will attribute the injuries to being clumsy or accident prone. They may be anxious and evasive during the interview and not make eye contact. Documenting Domestic Violence : Documenting Domestic Violence Suggested guidelines regarding documentation of domestic violence include the following: Be specific and objective when describing the signs and symptoms of injuries. Record the patient’s description of how the injury happened, using the patient’s own words. Direct quotes should be used and prefaced with “the patient states...” Document injuries for which the patient is seeking care and include other injuries in various states of healing. Describe size, location and age of injuries using a body map. The time of injury can be estimated from the color of the bruises. Include your opinion on whether the patient’s explanation is consistent with the injury. Documenting Domestic Violence : Documenting Domestic Violence Take photographs after obtaining the patient’s consent. Take photos from different angles, including the patient’s face. Label with the date and name of patient. Document on the back of each photograph the patient’s name. Record the amount of the patient’s distress as a finding. Note the interaction of the patient and possible patient abuser. Document any Health and Rehabilitation Services contacted. Notify the risk management in your institution. Collect forensic evidence in accordance with institutional policy and state laws. Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Once domestic violence has been uncovered and assessed, intervening in the situation is next steps. Victims, whether or not they are deciding to leave the abusive relationship, often require a variety of health, mental health, legal and social services. These can include: Healthcare services Shelter Financial Assistance Law enforcement involvement Legal service in order to obtain an injunctions Food stamps Other assistance Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Reporting Domestic Violence: It is important to tell the victim about his/her right to report the abuse. However the victim is not obligated to do so and cannot be forced or coerced into reporting. Professionals in the State of Florida are required to report child or elder abuse. Mandatory reporting of domestic violence is required only if the person is suffering from an injury inflicted by a weapon. Any legal intervention must be done with the victim’s knowledge and consent. Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Providing Information and Making Referrals: Issues of safety must be considered. If the batterer is present during the visit, employ strategies to ensure privacy. Written information, pamphlets, brochures, domestic violence hot-line numbers and addresses of shelters can place a victim at further risk if found by the batterer. Ask the patient if it is safe to take the information. Warn the patient to put any written information in a safe place where the abuser cannot find it. Assess for immediate need for shelter or crisis counseling. The victim may want to consider staying with a family member or friend. She/he should choose a location where the batterer is not likely to find them. Give information and telephone numbers of the community resources and legal options. Plan a follow-up appointment within a week and obtain the patient’s permission before making referrals or sharing information with other professionals. Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Filing an Injunction: Injunctions are available for victims of domestic violence to protect themselves and their children from abusers. Temporary injunctions can be obtained 24 hours a day, seven days a week. Judges will grant a temporary injunction based on a sworn petition filed with the clerk of the court. Neither evidence nor an attorney are required to file for a temporary injunction. It is important that the victim attend all hearings so that she/he can explain his/her needs to the judge. Within 15 days, a hearing will be held for a permanent injunction that may be granted for one year. The injunction will mandate that the victim has temporary custody of any children she/he and the abuser have together. Once an injunction has been filed, the victim becomes eligible through the court system for additional services including temporary child support, food stamps, and counseling for the victim and children. Intervening in Domestic Violence Situations : Intervening in Domestic Violence Situations Strategies for getting an effective police response include the following: Remain as calm as possible Ask the police to file a report Describe the assault in detail Show all injuries, bruises or damaged property Identify witnesses to the incident Describe other violent incidents Show any court documents you have (IE: restraining orders) Ask for community resources such as shelters, hotline, counseling and advocacy Ask for the case number of the report and a phone number if you want to follow up on the case Safety Plan : Safety Plan Before the violent incident: Be aware of escalating behavior Remove weapons from the house Ask a neighbor to call the police if they hear suspicious noises coming from your home Teach your children how to call the police (911), escape routes from the house and when to leave Plan where you would go in an emergency, somewhere your partner will not know to look for you Make a plan on how to leave Gather and hide items you need to make an escape such as money, keys, clothing, important documents, important phone numbers, valued personal items Safety Plan : Safety Plan After the violent incident: Check yourself and children for injuries, go to the hospital in necessary If you left your children behind, go to the police as soon as possible to get them checked in File a report with the police and consider an injunction. Remember the court order does not guarantee File a report with the police and consider an injunction. Remember the court order does not guarantee your safety. Live your safety plan. Seek help from a counselor or shelter to help you understand why this happened and how to prevent it. It may be the best gift you give yourself. Preventing Domestic Violence : Preventing Domestic Violence One message or method will not reach everyone. Consideration must be given to factors such as content, literacy, language preference, location of materials and cultural diversity. Include options and resources available in the community. As stated before,, sometimes you just planted the seed that domestic violence is not normal, not deserved and not acceptable. It may be the beginning of the end of domestic violence in a person’s life.