domestic violence

1. Dynamics of Interpersonal Violence
and the Childbearing Experience:
What Nurse-Midwives need to know
Developed and compiled by Tara Cardinal, MN, CNM,
ARNP

2. ۰ Describe 5 ways
 IPV impacts maternal and neonatal physiology
۰ Identify 3 ways
 to support a mother with a history of trauma anticipate potential
triggers and cope
۰ Identify 3 resources
 to support safety and effective help seeking in your patients
۰ Articulate 5 barriers
 legal, health and/or social - to leaving abusive situation while pregnant
۰ Familiarize self with the Power and Control wheel
۰ Describe 2
 guidelines or curriculum resources that will enhance your screening,
counseling and response
Objectives

3. ۰ Describe 5 ways
 IPV impacts maternal and neonatal health
۰ Identify 3 ways
 to support a mother with a history of trauma anticipate potential
triggers and cope
۰ Identify 3 resources
 to support safety and effective help seeking in your patients
۰ Articulate 5 barriers
 legal, health and/or social - to leaving abusive situation while pregnant
۰ Familiarize self with the Power and Control wheel
۰ Describe 2
 guidelines or curriculum resources that will enhance your screening,
counseling and response
Objectives

4. ۰ Mentors: Sheila Capestany, Shannon Harris, Leigh
Hofmeier, Lois Thetford
۰ Leaders in the field: Judith McFarlane, Julia Seng,
Jacquelyn Campbell, Kathleen Kendall-Tackett, Penny
Simkin
۰ Organizations: WCSAP, WSCADV, BC Women’s Health
Center
Acknowledgements

5. ۰Individual and collective
 Personal experience
 Professional experience
 Research endeavors
Acknowledging You

6. ۰ Assessment and modification at all levels of an
organization
 Ensure basic understanding of how trauma impacts
whole person
 Triggers and vulnerabilities
 Seeks to avoid re-traumatization
 Creating supportive services and work environments
Trauma Informed Care
(SAMHSA, 2013)
“Traumatic experiences can be dehumanizing, shocking or terrifying, singular or
multiple compounding events over time, and often include betrayal of a trusted
person or institution and a loss of safety.”

7. ۰ Short and long-term psychological and physiological
impacts on both a mother, her child, family,
community and society
۰ Perinatal care providers close relationships
 Intersection at critical time
 Safe/respectful environment
۰ Effective interventions improve safety and outcomes
۰ Women as experts in own reality
Basic Premises

8. ۰ The topic is extremely complex, multifaceted with
overlapping dimensions
۰ Uncoordinated approaches
۰ Research is fragmented
۰ Social and health services are fragmented
۰ Women’s perpetration of violence against their
partners
۰ Minor focus on perpetration of violence
A few caveats

9. ۰ Intimate partner violence (IPV) vs. domestic violence (DV)
۰ IPV
 “Pattern of assaultative and coercive behaviors that may include
inflected physical injury, psychological abuse, sexual assault,
progressive isolation, stalking, deprivation, intimidation, and
threats… aimed at establishing control by one partner over the
other.”
 Reproductive/sexual coercion
 “…involves behaviors to maintain power and control in relationship
related to reproductive health … behaviors that interfere with
contraception use and/or pregnancy.”
 Birth control sabotage, pregnancy pressure and coercion, sexual coercion
۰ Variations making research difficult
Definitions

10. ۰ Greater frequency than other high-risk conditions
۰ Increased prevalence in economically disadvantaged
communities and when higher margin of inequality
 Highest prevalence in tribal communities
۰ “…Maternal depression may itself represent the first
adverse life event to which one can be exposed.”
(Neigh, 2009)
Some of What We Know

11. ۰ 1 in 4 women physically /sexually assaulted by current or former
partner
۰ 40% teen moms experienced IPV
 66% on public assistance disclosed birth control sabotage
 3.5 times more likely to become pregnant than non-abused
 Of those seeking abortions:
 3 times more likely victimized than women continuing pregnancy (FWV,
2012)
۰ 66% of murdered women known to have experienced violence
beforehand (Plichta, 2005)
۰ Murder is the second most common cause of injury-related death
for pregnant women (31%) after car accidents. (Chang et al., 2005)
۰ 13-24% pregnancy associated deaths due to homicide (Plichta, 2005)
Who, When & How Much?

12. ۰ 13-50% report abuse in pregnancy as the first episode
۰ Research shows it is dramatically underreported and not
enough providers feel comfortable asking the questions.
۰ More common than gestational diabetes or preeclampsia
۰ One of the most common reasons for women and their children
becoming homeless
۰ 66% of murdered women known to have experienced violence
beforehand (Plichta, 2005)
۰ Murder is the second most common cause of injury-related
death for pregnant women (31%) after car accidents. (Chang et
al., 2005)
۰ 13-24% pregnancy associated deaths due to homicide (Plichta,
2005)
Who, When & How Much?

13. ۰ Increased child abuse occurrence with DV, “30-60% of
perpetrators of IPV also abuse children in
household.”
۰ “Witnessing violence between one’s parents or
caretakers is the strongest risk factor of transmitting
violent behavior from one generation to the next.”
Who, When & How Much?

14. ۰ Socio-cultural
 Oppression
 Macro-Micro
 Colonialism-Bullying
۰ Epidemic of the disease
۰ Public health problem
۰ Eradication lies at the root
 Clinical interventions reduce
harm and decrease spread
Roots of Violence

15. CHILDHOOD:
Exposure to
violence
BULLYING
DATING
VIOLENCE
ADULT IPV
Cycle of Overlapping Violence
Socio-cultural-historical ?
Dr. Claire Crooks, 2010

16. ۰ For some, abuse may begin or escalate in pregnancy.
۰ For others, it may decrease of pause.
۰ Some women are more likely to leave because their
pregnancy is a motivator for them
۰ It can also be a time of increased vulnerability where a
woman may feel more dependent on her abuser
Intersection of Violence and
Pregnancy
(WA DOH, 2008)

17.  Change dependent on:
 Readiness for change
 Flexibility with changing
context
 Resourceful but limited
 Tailored interventions
 Harm reduction
 Transtheoretical Model
of Change (Prochaska,
DiClemente, & Norcross,
1992)
 Haggerty & Goodman,
2003
Stages of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance

18. Stages of Change: Surviving Intimate Partner violence During and After Pregnancy
by Alice Kramer, MS, RN
(Kramer, 2007)

19. www.theduluthmodel.org

20. asafepassage.info
Jodi Hall, PhD

21. ۰ Demanding she care entirely for the infant and
household
۰ Asserting that the child will be raised according to his
customs and belief systems
۰ Demeaning her role as a mother
Power and Control
Male Privilege

22. ۰ Telling her she looks fat or making other derogatory
comments about her changing body
۰ Verbally abusing her so she is unable to care for
herself in pregnancy and postpartum
۰ Sabotaging her efforts to reduce or eliminate
substances that may be harmful to herself or their
developing baby
Power and Control
Emotional Abuse

23. ۰ Threatening to harm their child should she decide to
leave
۰ Trying to convince others that she is an unfit mother
۰ Threatening to call child protection agencies
Power and Control
Using Children

24. ۰ Increasing the severity/frequency of physical assaults
۰ Directing abuse towards her abdomen and or
genitalia
۰ Forcing her or not allowing her to breastfeed
Power and Control
Physical Abuse

25. ۰ Holding her solely responsible for the pregnancy
۰ Refusing to admit that he is the father of the child
۰ Blaming her for the child being the “wrong” sex
Power and Control Minimizing,
Denying and Blame

26. ۰ Forcing or causing an unwanted pregnancy through
direct means (sexual assault) or indirect means
(sabotaging contraception)
۰ Forcing her to engage in unwanted sexual activities
during the pregnancy or too soon postpartum which
could cause injuries
۰ Having an affair, transmitting STI’s to her, causing
risk to her and the fetus
Power and Control
Sexual Abuse

27. ۰ Threatening to leave her if she doesn’t have the child
۰ Threatening to harm her if she tells any of her
caregivers about the abuse
۰ Threatening to cause injury to their unborn baby
Power and Control
Coercion and Threats

28. ۰ Denying access to adequate food to support a
healthy pregnancy
۰ Making her work despite concerns for her health
۰ Refusing to pay for child related expenses
Power and Control
Financial Abuse

29. ۰ Making threatening motions towards her
۰ Throwing things at or near her, her pregnant body or
their baby
۰ Holding their baby during an argument
Power and Control
Intimidation

30. ۰ Preventing her from getting prenatal care
۰ Preventing her from accessing information regarding
her pregnancy
۰ Refusing or interfering with her contact with family
and friends
۰ Limiting her choice of caregiver and support people
for the pregnancy
Power and Control
Isolation

31. ۰ Physical, physiologic, psychosocial
۰ Social
۰ Economic
۰ Acute, chronic, intergenerational
 Ripples
 Social/behavioral
 Economic
 Epigenetic
 Life-course perspective
۰ Additive
Impacts of Violence

32. Potential Consequences of Violence
Physical Psychological Developmental
• Physical pain and harm to the
mother’s bodily integrity
• Miscarriage
• Placental abruption
• Preterm birth
• Premature rupture of
membranes
• Uterine rupture
• Hemorrhage
• Maternal and/or fetal death
• Depression
• Postpartum depression
• Anxiety
• Panic disorder
• PTSD
• High blood pressure
• High need for control
• Hyperarousal
• Substance use
• “Checking out,” numbing,
dissociation
• Isolation from peer support
• Low sense of self-worth and
esteem
• Difficulty advocating for own
desires with authority figures
• Difficulty breastfeeding
• Attachment difficulties
• Preterm labor
• Low birth weight
• IUGR
• Decreased blood flow to
uterus
• Changes in mother’s
hormones
• Increased infection
• Changes in baby’s genetic,
nervous and hormonal
systems and programming
that can last their entire
lifetime
Gluckman, 2008; Neigh et al., 2009; Rice & Records, 2008; Seng, 2002
Impacts

33. Impacts - Neonate
0
20
40
60
80
100
120
140
Maternal
cortisol
Newborn
(NB) cortisol
pre
NB heart
rate post
NB HR 5 min
post
NBcortisol
25 min post
NB HR 25
min post
Abused mothers
Non-abused mothers
Physiologic measures pre and post PKU heel stick
Suggest altered HPA axis in newborn
(Rice & Records, 2008)

34. ۰ Adverse Childhood
Experiences
 “Adverse Childhood
Experiences (ACEs) is the term
given to describe all types of
abuse, neglect, and other
traumatic experiences that
occur to individuals under the
age of 18. The landmark Kaiser
ACE Study examined the
relationships between these
experiences during childhood
and reduced health and
wellbeing later in life.”
Youth - ACEs
CDC, 2013

35. ۰ Adverse Childhood Experiences (ACE’s)
Youth - ACEs
CDC, 2013

36. Youth - ACEs
CDC, 2013

37. Youth - ACEs
CDC, 2013

38. ۰ Lowered self-esteem
۰ Substance use
۰ Eating disorders
۰ Obesity
۰ Risky sexual behaviors
۰ Teen pregnancy
۰ Depression
۰ Trauma
۰ Anxiety
۰ Suicidality
Impacts - Adolescence

39. Protective Factors
۰ Support system
۰ Past experiences coping and surviving
۰ Unique identification of strengths and resources
۰ Work experience – ability to get a job
۰ Access to resources, social capital
۰ Lack of a language barrier
۰ Community support and accountability

40. Interplay of Risk Factors and Adverse Events with those that
Buffer, Protect, enhance Resiliency
Shonkoff, 2010

41. ۰ Women
 More likely to be abused in a relationship
 More likely to abuse children
۰ Men
 More likely to be abusive to partners and children
Adulthood

42. Intervening
Connecting to caring and
fostering resilience

43. ۰ Provider
۰ “Weaving a safety net”
۰ Organizational change
۰ Multidisciplinary commitment and collaboration
۰ Beyond healthcare: Social, cultural and economic
Interventions

44. Interventions
Doyle, 2009

45. ۰ Routine assessment , counseling and education
 Referral as necessary
۰ Group prenatal care
 Centering Pregnancy
۰ Nurse Family Partnership
۰ Social, emotional and parenting skills support
۰ Cognitive Behavioral Therapy
۰ Mentoring
۰ Turnaway Study - ANSIRH
۰ Findings suggest women receiving abortions more
successful at escaping violent situation and partner than
women denied and forced to carry to term.
۰ “…interrupt transmission, prevent future spread, change group
norms in order to reverse epidemic …violence responds as a
disease, validated in its outcome …” (Gary Slutkin, TEDMED)
Interventions

46. Screening and Referral

47. ۰ Confidentiality
 Professional interpreter services
۰ Trust
 “I’m really glad you came in today. Before we get started I
want you to know that everything you share with me is
confidential, unless state laws/mandatory reporting
requirements applicable to you, those things I would have
to report, ok?” (Futures Without Violence, 2012)
 Safety and health
Ask: Limits to Confidentiality

48. ۰ Written and verbal screening
 Standard, routine questioning
 Instruments
 CDC: Intimate Partner Violence and Sexual
Violence Victimization Assessment
Instruments for Use in Healthcare Settings
 New OB Visit packet
 Share with Women
 Safety cards
 Intake forms
 Verbal
 Screening
۰ Safety cards
۰ History taking
 Probing
۰ Concerns
۰ Clarifying
 Non-disclosure
Ask
“Because these experiences are so common in women’s lives we ask all our
patients ….”

49.  “Because the following experiences are common in so many
women’s lives, and because, even if they have been dealt with
in the past, they can be triggered in pregnancy. Have you ever
felt hurt in a physical or sexual way? Do you feel safe in your
current relationship?”
 Concerned: “What you are telling me about your relationship
makes me wonder if there are other things that make you
uncomfortable. Has there ever been a situation where he has
hurt you or made you have sex when you didn’t want to?”
 Non-disclosure: “I am really glad to hear nothing like this is
going on for you. Should that ever change, this is a safe
place to talk.”
Ask

50. ۰Disclosure
 Validate
 Empathize
 Supportive statements
 Anticipatory guidance
Acknowledge

51. ۰ Safety
۰ “Do you feel safe to go home today?”
۰ “Are you afraid your partner may seriously harm you? Your children?
۰ “What is your plan to protect yourself and children from harm?”
۰ Need for evidence collection
۰ Perceived needs – “What can be done to support you?”
 Health
 Children
 Economic
۰ Coping
 Support network
۰ Develop an immediate safety plan
Assess

52. ۰ Domestic violence program
 Domestic Violence advocate
۰ Law enforcement and courts
 Legal advocate
۰ Social work
۰ Specialty care
Refer

53. ۰Domestic violence advocates
 Affiliation
 Program vs. prosecutor
۰ Program/shelter
۰ YWCA
 State regulations
 Training involved
Domestic Violence Advocate

54. ۰You care about her health and safety
۰Safe space
۰Abuse is not her fault
۰Follow-up plan
Assure
(WA DOH, 2008)

55. ۰ Perinatal Health Safety Card
 How is it going?
۰ All moms deserve healthy relationships
 On bad days?
۰ Is my relationship disrespectful
 How is your health? How are you coping ?
۰ Coping strategies
 Parenting is hard work
۰ Parenting after being hurt by someone you
know and love can make the work even
harder
 Who controls pregnancy decisions?
 Taking control back
Safe Homes, Safe Babies

56. ۰ General Health Safety Card
 Healthy vs. unhealthy relationship
 Encourages:
۰ social support
۰ stress reduction
۰ help seeking
 Safety planning
 Health effects
 Impacts on children
۰ Positive emotional support
۰ Help seeking
Is your relationship affecting your
health?

57. ۰ Reproductive Health
Safety Card
 Healthy vs. unhealthy
 Negative reproductive
health impacts
 Reproductive options
 Reproductive control
 Safety planning
Did you know your relationship
affects your health?

58. ۰ Trauma informed services
۰ Anticipatory guidance with check-ins
 Birth plan
 Trigger identification and coping
 Safe word
 Safety plan
 PTSD
 Dissociation
 Re-experiencing
۰ Social work and mental health consults
۰ Survivor Moms by Seng & Sperlich and When Survivors Give Birth
by Simkin & Klauss
Triggers and Coping

59. ۰ Health records being used in court cases
 Against women:
 No indication of abuse
 Unfit mother
 Credibility
 Substance use
 Inconsistencies
 Defend perpetrator’s character
 She has an agenda against abused
 Health records to be objective, reliable and sources of
relevant facts
Documentation
Cory et al., 2003

60. ۰ Routine counseling and screening for IPV and coercion
۰ Why screening was not done, plans to follow-up
۰ Response to screening
۰ Resources provided
۰ Referrals provided
۰ Follow-up appointment
۰ National Consensus Guidelines on Identifying and
Responding to Domestic Violence Victimization in Health
Care Settings
 by The Family Violence Prevention Fund (Futures Without Violence)
Documentation

61. ۰ Medical history
 LMP
۰ History
 Date & time
 Location
 Assailant name/info
 Mechanisms of injury
 Patient narrative
۰ Physical assessment
 Exam to include injury
 Photos/body maps
۰ Plan
 Interventions
 Collection of evidence
 Labs*
 STI’s
 Wet mount
 Serum for HIV eval, hep B, syphilis
 Medications
 Emergency contraception
 Post-exposure prophylaxis
 GC/CT & Trich
 Referrals
 To include DV/SA advocate
۰ Shelter, YWCA, hotline, etc.
 Mandatory/patient sanctioned reporting
 Recommended follow-up
 Repeat labs 1-2 weeks
 Safety plan
 Answer questions
 Timeline/guideline for evidence processing
 Follow-up
 Repeat testing
 Specialty care
Documenting Sexual Assault and
Abuse

62. ۰ Primary ICD-10 Codes
 E967.3 – Y07.03 – Male partner as perpetrator of maltreatment and neglect
 E967.3 – Y07.01 – Husband as perpetrator of maltreatment and neglect
 E967.3 – Y07.04 – Female partner as perpetrator of maltreatment and neglect
 E967.3 – Y07.02 – Wife as perpetrator of maltreatment and neglect
 995.81 – T74.31XA – Adult emotional/psychological abuse
 995.81 – T74.11XA – Adult physical abuse
 995.81 – T74.91XA - Abuse of partner
 V49.89 – Z91.89 – At risk for intimate partner abuse
 V23.89 – O9A.319 – Domestic violence affecting pregnancy
 648.93 – O9A.311 – Domestic violence affecting pregnancy in first trimester
 648.93 –O9A.312 – Domestic violence affecting pregnancy in second trimester
 648.93 – O9A.313 – Domestic violence affecting pregnancy in third trimester
 V11.8 – Z87.898 – History of violence
 V61.11 – Z69.11 – Spouse/partner abuse victim counseling
Coding

63. ۰ USPTF
 The USPSTF recommends that clinicians screen women of
childbearing age for intimate partner violence, such as domestic
violence, and provide or refer women who screen positive to
intervention services. Grade B recommendation 2013
۰ ACNM
 “Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs),
as advocates for and providers of primary women’s health care,
have a critical role to play in mitigating the effects of violence in
women’s lives.”
 CNMs and CMs must understand the dynamics of violence against
women and the impact of violence on the lives of women and their
children.”
 Appropriate assessment, intervention and referral for violence
against women should be an integral part of all midwifery care.”
 ACNM Position Statement on Violence Against Women
Recommendations

64. ۰ ACOG
 Based on the prevalence and health burden of IPV among
women, education during obstetric visits; and ongoing clinical
care can improve the lives of women who experience IPV.
Preventing the lifelong consequences associated with IPV can
have a positive effect on the reproductive, perinatal, and
overall health of all women.
۰ IOM
 Recommendation 5.7: The committee recommends for
consideration as a preventative service for women: screening
and counseling for interpersonal and domestic violence.
Screening and counseling involve elicitation of information
from women and adolescents about current and past
violence and abuse in a culturally sensitive and supportive
manner to address current health concerns about safety and
other current or future health problems.
Recommendations

65. ۰ IOM 2011 Report Clinical Preventative Services for Women: Closing the Gaps
۰ Routine screening and counseling
 8/1/2012
۰ Prohibit insurance company discrimination
 1/1/2014
۰ Reduction of teen pregnancies
۰ Tribal community support, prevention and treatment
۰ Home visitation and early childhood health
 Safety card development
۰ Articulated as part of the National Prevention Strategy with ACA
 One of 7 national priorities
 “Injury and Violence Free Living”
Affordable Care Act
Futures Without Violence, 2012

66. ۰ Future’s Without Violence
۰ HRSA
۰ CDC
۰ CDC/ACOG
۰ ARHQ
۰ Washington State
Department of Health
۰ SHE Framework
۰ March of Dimes
 Abuse During Pregnancy
Resources

67. ۰ Addressing Intimate Partner Violence, Reproductive
and Sexual Coercion: A Guide for Obstetric,
Gynecologic and Reproductive Health Care Settings
۰ National Consensus Guidelines on Identifying and
Responding to Domestic Violence Victimization in
Health Care Settings
۰ Safety Cards
۰ Webinars
۰ Fact Sheets
Futures Without Violence
Formerly Family Violence Prevention Fund

68. ۰ SHE Framework: Safety and Health Enhancement for
Women Experiencing Abuse: A toolkit for health care
providers and planners
 by Jill Cory and Lynda Dechief from the BC Women’s
Hospital and Health Center and BC Institute Against
Family Violence 2007
 Comprehensive resource
 Process for establishing solid Trauma Informed Care
SHE Framework

69. ۰ A Comprehensive Approach for Community Based
Programs to Address Intimate Partner Violence and
Perinatal Depression January 2013
 Raising awareness
 Forming partnerships
 Developing cultural competency
 Addressing policy
 Implementing standards of care guidelines
HRSA

70. ۰ Domestic violence as reportable varies by state
 Use of weapons
 Exposure of children
۰ “Often women who have had experience with domestic
violence have concerns about their child’s safety. Do you have
any concerns for your child?”
 No: resources available if this changes
 Yes: disclose mandatory reporter status
 “I care about you and your child, and I need to ask you some
questions about the safety of your child. Because of my professional
responsibilities, I’m required to report any abuse or neglect of a
child. Before we begin, do you have any questions about this?”
Mandatory Reporting
(WA DOH, 2008)

71. ۰ Compendium of State Statutes and Policies on
Domestic Violence and Health Care produced by the
Family Violence Prevention Fund
۰ Fatality Review Teams
۰ Mandatory Reporting of Domestic Violence to Law
Enforcement by Health Care Providers
۰ Insurance discrimination
State by State

72. ۰ Research
 Quality
 Congruence and replication – little that has been done not “significant”
۰ Standardization
 Screening – universal, methodology
 Definitions
۰ Awareness
 Issue – IPV, impacts
 Prevention – you can have a role
 Interventions – can help! Interrupt, …, change norms
۰ Resources
 Time – clinician, training programs, practice
 Economic - reimbursement
 Emotional – secondary trauma, personal experiences and denial
Limitations in Research

73. ۰ Increase awareness
 you may have increased yours today, take this back to your
colleagues, organization, and community
۰ comprehensive screening , counseling, education in your
practice
۰ Commit as an individual and organization to the process of
ensuring Trauma Informed Care
۰ Collaborate
۰ Research
 Sustainability of provider screening
 Amount of abuse
Next Steps

74. ۰ Bevans, K., Cerbone, A., & Overstreet, S. (2005). Advances and future directions in the study of children’s neurobiological responses to trauma and violence exposure.
Journal of Interpersonal Violence, 20(4), 418-425.
۰ Casanueva, C.E., & Martin, S.L. (2007). Intimate partner violence during pregnancy and mothers’ child abuse potential. Journal of Interpersonal Violence, 22, 603-622.
Found at: http://jiv.sagepub.com/cgi/content/abstract/22/5/603
۰ Coid, et al. (2001). Relation between childhood sexual and physical abuse and risk of revictimization in women: a cross-sectional survey. Lancet, 358, 450-454.
۰ Humphreys, J., & Campbell, J. C. (2010). Family Violence and Nursing Practice (2nd ed.). New York: Springer Publishing Company.
۰ Edelson, J.L. (1999). The overlap between child maltreatment and woman battering.” Violence Against Women. 5, 134-154
۰ Espinosa, L. & Osborne, K. (2002). Domestic violence during pregnancy: Implications for practice. Journal of Midwifery & Women’s Health, 47, (5), 305-317. PMID:12361342
۰ Grip, K., Almqvist, K., & Broberg, A. G. (2011). Effects of a Group-Based Intervention on Psychological Health and Perceived Parenting Capacity among Mothers Exposed to
Intimate Partner Violence (IPV): A Preliminary Study. Smith College Studies in Social Work, 81(1), 81–100. doi:10.1080/00377317.2011.543047
۰ Intimate Partner violence. 2012. ACOG Committee Opinion number 518.
۰ Jouriles, E. N., McDonald, R., Rosenfield, D., Stephens, N., Corbitt-Shindler, D., & Miller, P. C. (2009). Reducing conduct problems among children exposed to intimate
partner violence: A randomized clinical trial examining effects of Project Support. Journal of Consulting and Clinical Nursing. 21(4), 236-297. doi: 10.10Psychology, 77(4), 705–
717. doi:10.1037/a0015994
۰ Kramer, A. (2007). Stages of Change: Surviving Intimate Partner violence During and After Pregnancy. Journal of Perinatal & Neonatal 97/01.JPN.0000299786.16667.4f
۰ Lazenbatt, A., Taylor, J., & Cree, L. (2009). A healthy settings framework: An evaluation and comparison of midwives’ responses to addressing domestic violence.
Midwifery, 25, 622–636 DOI:10.1016/j.midw.2007.11.001
۰ Miller, E., Decker, M. R., McCauley, H. L., Tancredi, D. J., Levenson, R. R., Waldman, J., Schoenwald, P., et al. (2011). A family planning clinic partner violence intervention to
reduce risk associated with reproductive coercion. Contraception, 83(3), 274–280. doi:10.1016/j.contraception.2010.07.013
۰ National Coalition Against Domestic Violence (NCADV). Domestic violence facts. Retrieved from
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