Download to read offline
More Related Content
Hv medical
- 1. DOVE, Inc. iscommitted to serving communities, families and individuals impacted by domestic violence. We seek to empower our clients and the community by providing safety, shelter, education and support services. By promoting an environment free from abuse, we strive to see DOmestic Violence Ended.
- 2. Shelter Program Founded 34years ago 18 beds families, singles, children men/women/transgender Victims are accepted regardless of gender or sexual orientation Visiting Nurse and Counselor Support Groups 24 hour Hotline Individual Advocate Meetings
- 3. Community Advocacy Serving clientsin the community Support groups Individual advocacy & counseling Legal Advocates Court Outreach Program Civilian DV Advocate Sexual Assault counselor Outreach Teen Dating Violence Prevention Educational Workshops
- 4. U.S. Preventive ServicesTask Force 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. This recommendation applies to women who do not have signs or symptoms of abuse. Affordable Care Act Screening and counseling for interpersonal and domestic violence will be covered for all adolescent and adult women. An estimated 25% of women in the United States report being targets of intimate partner violence during their lifetimes. Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women. Patient Satisfaction increased when asked about DV Why are we here?
- 5. Impact on Health Inaddition to injuries sustained during violent episodes, physical and psychological abuse are linked to a number of adverse physical health effects including arthritis, chronic neck or back pain, migraine and other frequent headaches, stammering, problems seeing, sexually transmitted infections, chronic pelvic pain, and stomach ulcers. Coker, A., Smith, P., Bethea, L., King, M., McKeown, R. 2000. “Physical Health Consequences of Physical and Psychological Intimate Partner Violence.” Archives of Family Medicine. 9
- 6. Definition of DomesticViolence Domestic Violence also known as battering, is a pattern of behavior used to establish power and control over a partner, friend or any other person through fear and intimidation, often including the threat or use of violence. While the violence may cause injury, it does not have to be physical. Domestic Violence also takes the form of emotional verbal sexual and economic abuse. Domestic Violence affects people of all ethnic, racial and economic backgrounds. It affects women, men, and transgendered people. It takes place in same sex relationships as well as heterosexual relationships. Battering happens when one person believes that they are entitled to control another. Assault, battering, and domestic violence are crimes”. Definition taken from the National Coalition Against Domestic Violence and Jane Doe Inc.
- 7. Statistics Girls and womenbetween the ages of 16 and 24 experience the highest rates of DV and sexual assault Relationship violence is the number one cause of injury to women ages 15-44: more than rapes, muggings, and car accidents combined. Every day at least 3 women are murdered by their husbands or boyfriends in this country. 1 in 4 GLBT people are battered by a partner at some point in their lives. *Statistics from the US dept of justice, Center for disease control and Prevention, Center for Community Solutions, American Psychological Association, and the Bureau of Justice Statistics Special Report
- 8. Health Care Costs TheCenters for Disease Control and Prevention estimates that the cost of intimate partner rape, physical assault and stalking totaled $5.8 billion each year for direct medical and mental health care services and lost productivity from paid work and household chores. Costs of Intimate Partner Violence Against Women in the United States. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2003. Available at http://www.cdc.gov/violenceprevention/pdf/IPVBook-a.pdf. Max, W, Rice, DP, Finkelstein, E, Bardwell, R, Leadbetter, S. 2004. The Economic Toll of Intimate Partner Violence Against Women in the United States. Violence and Victims, 19(3) 259-272.
- 9. Health Care Costs Ofthis total, nearly $4.1 billion are for direct medical and mental health care services and productivity losses account for nearly $1.8 billion in the United States in 1995. When updated to 2003 dollars, the cost is more than $8.3 billion. Costs of Intimate Partner Violence Against Women in the United States. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. 2003. Available at http://www.cdc.gov/violenceprevention/pdf/IPVBook-a.pdf. Max, W, Rice, DP, Finkelstein, E, Bardwell, R, Leadbetter, S. 2004. The Economic Toll of Intimate Partner Violence Against Women in the United States. Violence and Victims, 19(3) 259-272.
- 10. In One Day 2011National Census of Domestic Violence Services 1,799 Victims of DV accessed an array of services in MA 788 found shelter 1,011 benefitted from individual counseling, legal advocacy and support groups 596 hotline calls 25 calls every hour 479 unmet needs due to shortage of funds and staff for housing, mental health counseling and legal representation (national Network to End Domestic Violence, 2011)
- 11. 5 Types ofAbuse Physical Financial Emotional/Mental/Psychological Verbal Sexual
- 12. Physical Abuse Slapping/ Punching Kicking Spitting Pinching Pushing/Shoving Biting Useof weapons Throwing objects Throwing person down stairs Choking/ strangulation Denial of physical needs; sleep, food, medical attention
- 13. Financial Refusing partner accessto money for food, clothing and basic needs Controlling all assets (car & house) Putting all the bills in the partners name Running up charges Ruining credit
- 14. Verbal Threats such as‘You’ll be sorry’, ‘I’m going to let you have it’ Threats to disclose information about partner that is confidential (such as past abuse) Yelling, screaming Swearing, name calling
- 15. Sexual Manipulation Guilt tripping Coercing Forcing degradingsexual acts Comments like whore or slut Exposing self Penetration Jokes or insults Unwanted touching or groping
- 16. Emotional/ Mental/ Psychological Continuedattacks on self esteem Repeated harassing Interrogating Degradation Threats to withhold money Take children Have an affair Insults Controlling Forcing to stay awake Blaming for all the goes wrong Isolation
- 18. Myths Mental Illness Low selfesteem Substance abuse Anger management Provocation External stressors FACT: ABUSE IS A CHOICE
- 19. Screening for DV Oldscreening question : Do you feel safe at home? New screening questions: open ended, behavioral How are things at home? Has your partner ever hit, kicked, shoved or punched you? Does your partner put you down? Have you ever felt afraid of your partner?
- 20. How to Ask Screenthe patient for IPV alone Use your own words, ask questions in a supportive and non judgmental manner Ask direct, simple and behaviorally specific questions Ask about their ‘partners’ as opposed to ‘husband’ or ‘spouse’ Don’t use terms like ‘battered’ or ‘abused’ Show compassion and understanding for people’s choices
- 21. Normalizing the Question “Becauseabuse and violence are so common in people's lives, I have begun to routinely ask about abuse.” “I do not know if this has ever been a problem for you, but because so many women I see are dealing with abusive relationships I've started asking about it routinely.”
- 22. Normalizing the Question “Wenow know that violence affects many families. Violence in the home may result in physical and emotional problems for you and your child. We are offering services to anyone who may be concerned about violence in their home.” “Because there is help available for women who are being abused, I now ask every woman about DV.”
- 23. Time Concerns It takes6-10 seconds to frame the issue and ask a screening question Approximately 85% of patients will screen negative for IPV You have let the patient know that this is an important health issue and your office is willing to help if needed Taliaferro, E., Surprenant, Z. Medical Directions, 2006. Respond to Intimate Partner Violence; 10 Action Steps you can take to help your patients and your practice.
- 24. Time Concerns It takes2-3 minutes to deal with most patients who screen positively for IPV About 14% will give a positive response Most will be in ‘stable IPV’ (non urgent) Provide rapid assessment of immediate safety Will take longer to help the > 1% that respond positively and have urgent needs Taliaferro, E., Surprenant, Z. Medical Directions, 2006. Respond to Intimate Partner Violence; 10 Action Steps you can take to help your patients and your practice.
- 25. Follow up Questions Atminimum, ask some of the following: Are you afraid your life may be in danger? Do you feel safe at home with your partner? Do you have somewhere safe to go? Has there been an escalation in the violence? Have weapons or threats been used? Has your partner choked or strangled you? Do you know what to do if the situation becomes dangerous (call 911, have safety plan)
- 26. Responding to Disclosures “Idisclosed when someone appeared to care about the answer.” - patient “I’m glad you told me. We see many other patients in similar situations. No one deserves to be abused. I want to connect you with someone to talk to.” - doctor
- 27. Red Flags An injury/eventthat is inconsistent with the client’s history (I fell playing a sport) A changing, inconsistent history or vague description of the cause of an injury/event Minimization of the injury/event A delay in seeking care for significant medical conditions
- 28. Red Flags Missed orcanceled appointments Partner canceling Unusual behavior between patient and partner Suggestive trauma patterns Multiple visits to ER, injuries in various states of healing, defensive wounds
- 29. If a Patientdoes not Engage Use indirect statements and questions when a patient has denied IPV, but you feel it is a possibility I am asking you this because I am concerned about your safety Are you having problems with your partner? Do your arguments ever become physical? Are you ever afraid? Have you ever gotten hurt? You seem concerned about your partner. Can you tell me more about that? You mentioned your partner uses alcohol. How do they act when they become intoxicated? Does their behavior frighten you?
- 30. If a Patientdoes not Engage Goal is NOT disclosure Goal is to create a culture of SUPPORT
- 31. When should screeningoccur During new patient exams Annually During episodic visits, if indicators are present When patient enters new intimate relationship If patient is pregnant, once a trimester and during postpartum Family planning visits, STI visits, abortion clinics, fertility clinic visits
- 32. High Risk Indicators Historyof Violence/ Past Assaults Threats to kill (partner, child, pet) Access or use of weapons Obsessive jealously and/or preoccupation with partner Stalking or monitoring partner Strangulation Forced Sex
- 33. Risk to theVictim Stay -Physical injury -Death -Physical or psychological harm to children -Loss of children -Loss of income/job -Loss of family, friends and support -Loss or damage to possessions Leave -Physical injury -Death -Physical or psychological harm to children -Loss of children -Loss of income/job -Loss of family, friends and support -Loss or damage to possessions
- 34. Victim Blaming Statements ClientsMay Hear Did you try to stop the abuse? What did you do to provoke it? Why don’t you just leave? It can’t be that bad. If someone treated me like that I know I would just leave. That happened a while ago, can’t you just forget about it? He would never do that (don’t believe the victim).
- 35. Recap Create a safeplace to disclose Support patient Refer to outside services
- 36. Awareness Information Posters “Let us know, we can help” Restrooms Exam room Online Health Ed Classes Engaged and informed workforce
- 38. In practice Domestic Violencework is based on models which uphold client’s right to self determination Safety Planning Education Options Resources CLIENT IS EXPERT
- 40. Contact Information Crisis Hotline617 471 1234 Community Office 617 770 4065 Safelink 1 877 785 2020 All services are free and confidential www.dovema.org www.janedoe.org
Editor's Notes
- #34 There are many risks associated with leaving and staying in an abusive relationship. After reading the list of risks to a victim if he or she stays, what are some potential risks that someone might face if they leave an abusive partner?