The document discusses domestic abuse, defining it as physical or attempted physical harm between household members under South Carolina law. It provides statistics on domestic violence services in South Carolina, noting barriers to addressing abuse like lack of knowledge and time. The victims of domestic violence come from all backgrounds, and it is most commonly perpetrated against women. Children who witness abuse are also severely impacted. Leaving an abusive situation is a process for victims due to factors like fear, low self-esteem, isolation, lack of resources, and promises from the abuser to change. Healthcare providers have an important role in identifying abuse and referring victims to support services.

1. Domestic Abuse
SANE 2012

2. ‘Probably the most important
contribution to ending abuse and
protecting the health of its victims is to
identify and acknowledge the abuse’
Council on Ethical and Judicial Affairs, American
Medical Association

3. State Definition
According to S. C. Code of Laws Ann §16-25-20,
“domestic violence” is defined as
• Causing physical harm or injury to a person’s
household member;
• Offering or attempting to cause physical harm or
injury to a person’s own household member with
apparent present ability under circumstances
reasonably creating fear of imminent peril.”

4. SC Stats
Domestic Violence FISCAL YEAR 2009 - 2010
Number emergency shelters funded 13 programs with 18 shelters
Number Batterer Intervention
Program Funded and Non-funded
8 Funded programs with 30 Non
Funded programs
Number individuals receiving
emergency shelter
3,192
Number women/children & men
receiving myriad of services
19,850
Number of hotline calls 25,584
Number of approved Batterer
38
Intervention Programs
Number of batterers receiving
counseling services
3,295

5. Barriers
1) Lack of knowledge
2) Lack of Confidence in Intervention
3) Lack of time

6. THE VICTIMS
• Domestic violence happens between
people who are dating, married,
separated, and divorced.
• It occurs in heterosexual as well as in
gay and lesbian relationships and in
adolescent dating relationships.

7. Who are the
VICTIMS?
Victims cross all socio-economic,
religious, racial, ethnic, age groups

8. THE VICTIMS
Stacy
First American woman to summit
Mount Everest
“When people meet me, and find out that
I’ve been in an abusive relationship…
they just can’t believe it.”
“Looking at me, with all the things I’ve done
in my life..
They think, how could I have been in a
relationship like that?”

9. THE VICTIMS
• Women represent 95% of adult victims
• Between 1 and 4 million women abused per
year
• Lifetime risk for women is about 20%

10. THE VICTIMS
Domestic violence is the leading cause of
injury to women ages 15-44 in the
United States

11. THE VICTIMS
Research suggests DV results in more
injuries to women requiring medical
treatment than rape, auto accidents and
muggings. (US Senate Judiciary Committee,
1992; Stark & Flitcraft, 1988)

12. THE VICTIMS
• Abused women comprise approximately
11-30% of women presenting with injury to
hospital emergency services.
• Medical expenses from domestic violence
total at least $3 to $5 billion annually.

13. DYNAMICS OF
DOMESTIC VIOLENCE
POWER
AND
CONTROL

14. Dynamics
• A pattern of assaultive and coercive behavior
– Physical
– Sexual
– Psychological
– threats
– intimidation
– emotional abuse
– isolation
– Economic

15. DDYYNNAAMMIICCSS OOFF
DDOOMMEESSTTIICC VVIIOOLLEENNCCEE
“Either dinner wasn’t exactly what
he wanted, the house wasn’t
immaculate, I didn’t look
presentable enough… any excuse at
all, really… and it was always my
fault.”
“ It was very debilitating,
I ended up walking on eggshells.
I began questioning my own
competence to do anything.”

16. THE DYNAMICS OF
DOMESTIC VIOLENCE
• “It started out slowly. At first he just wanted to
know where I was going all the time. Then he
wanted to tell me where I was going all the time. By
the end, I wasn’t allowed to go anywhere.”
• “If I went out with my girlfriends, I knew I would
come back to find the house trashed… he would
always break something he knew I really cared
about.”

17. Who are the
BATTERERS?
Batterers ccrroossss aallll ssoocciioo--eeccoonnoommiicc,,
rreelliiggiioouuss,, rraacciiaall,, eetthhnniicc,, aaggee ggrroouuppss

18. Characteristics of
Batterers
Sense of Entitlement
Controlling
Manipulative
Frequently Charming
Uninvolved parent
Show contempt for others
Lundy Bancroft - Emerge

19. THE BATTERERS
• DV Is Learned Behavior by Batterers
• DV Is NOT Caused By:
– Illness
– Genetics or gender
– Alcohol or other drugs
– Anger
– Stress
– Victim’s behavior
– Relationship problems

20. What Makes Batterers So Powerful?
• Isolation of victim
• Societal Denial
• Use of Religious Issues
• Use of Cultural Issues
• Threats of Retaliation

21. THE CHILDREN
Perpetrators of domestic violence
traumatize children
1. Physical Injuries
Intentional
Unintentional
2.Psychological Injuries
Witnessing Violence

22. THE CHILDREN
Effect on Children:
• In 85% of police calls for domestic violence, children
had witnessed the violence
• Witnessing parental violence is a risk factor for:
Males- to physically abuse
Females- to become victims of abuse

24. DOMESTIC VIOLENCE
Entry into the health care system represents an
opportunity for detection of domestic
violence and referral to appropriate
community resources

25. DOMESTIC VIOLENCE
and the Emergency Department
• 30% of all female trauma patients
• 22-35% of all females presenting to the
Emergency Department
• most are repeat ED patients
• 20% 11 or more abuse related visits
• 23% 6-10 abuse related visits

26. DOMESTIC VIOLENCE
SEQUELAE
In the 12 m o n t h p e r io d f o l l o w i n g v i o l e nce:
– Victims use health care services twice as
often as non-victims
– Healthcare costs were 2.5 times higher for victims
Victimization was the single best predictor of
total yearly physician visits and of outpatient
health care costs

27. FAILURE TO DIAGNOSE
DOMESTIC VIOLENCE
• Inappropriate treatment
• Increase victim’s sense of helplessness and
entrapment
• Lost opportunity to refer to appropriate
community resources
• Increase danger to the patient

28. Opening Pandora’s Box:
Why physicians do not ask
patients about domestic
violence
#1 Not enough time -71%
#2 Fear of offending the patient-55%
#3 Powerlessness to intervene -50%
#4 No control over patient behavior 42%
#5 Too close for comfort -39%

29. What do I do if she says, “Yes?”

30. ACKNOWLEDGE - You Have
Heard What the Patient Said
• Use supportive statements: “You don’t deserve
this.” and, “Our concern is for your safety and
your kids’ safety.”
• Affirm her autonomy and right to control
decision-making.

31. What to do if she says, “Yes!”
The single most important thing you can do
is to communicate the message
NO ONE DESERVES TO BE HURT LIKE THAT

32. REFER - Intervention With a
Victim
• Be aware, materials and referrals you provide
a victim may place her in danger
• Make a follow-up appointment

33. Why don’t they just leave?
FEAR
LOW SELF ESTEEM
ISOLATION
LACK OF RESOURCES
PROMISES TO CHANGE

34. FEAR SEPARATION VIOLENCE
• 73% of battered women seek emergency medical services
after separation (Stark, 1981)
• Up to 75% of domestic assaults reported to police are made
after separation (US Dept. of Justice, 1995)
• Women are most likely to be killed when attempting to
report abuse or leave the abuser (Sonkin, 1985)
• Approximately one-half of males who kill their wives, do so
after separation (Hart, 1992)

35. FFEEAARR
“Everyone seems to think that what
you need to do is to just leave the
relationship and then everything will
be fine.”
That’s the myth. The reality is that the
violence escalates if you try to get
away.
“I knew that not only did I have to
leave, I had to DISAPPEAR.”

36. LLOOWW SSEELLFF EESSTTEEEEMM
“I thought that I was worthless,
that I couldn’t do anything right.”
I thought I was ugly, just a
horrible individual … no one
would ever love me and I myself
was incapable of love.”
Stacy
First American Woman to summit
Mount Everest

37. LLEEAAVVIINNGG IISS AA PPRROOCCEESSSS
“I think I left 12 times before I finally
stayed gone.
When I look back on it now, I realize
I was practicing. It was a process…
it took time, I had to learn how to
leave and I had to learn how to stay
gone.”

38. PPrroommiisseess ttoo CChhaannggee
“I don’t really know why I
kept going back...
He begged me to, swore
he’d never do it again.”
“And, I wanted to hear it.
I was overweight, I felt
unloved…”

39. LLAACCKK OOFF RREESSOOUURRCCEESS
“After years of violence, I was completely
bewildered. I didn’t know how to get
away!”
There has to be a place to go to, its not just
a matter of leaving from someone. And, for
many victims of domestic violence that
place either doesn’t exist or they don’t
know that it exists.

40. Leaving is a Process
• Safety Issues
• Threats of Retaliation
• Fear of Talking about Abuse to Others
• Breaking Isolation
• Access to Resources
• Survival Strategies
• Batterer Accountability

41. Leaving Is a Process
• SURVIVORS OF DOMESTIC VIOLENCE DO
LEAVE!
– They leave when they are ready
– They leave when it is safe to do so
– We can support their process by providing an
institutional response affirming battered women and
their decision making ability

42. THE VICTIMS
Domestic violence is the leading cause of
injury to women ages 15-44 in the
United States

43. THE CHILDREN

44. ‘Probably the most important
contribution to ending abuse and
protecting the health of its victims is to
identify and acknowledge the abuse’
Council on Ethical and Judicial Affairs, American Medical
Association