Transcript Intimate Partner Violence

ASK. LISTEN. ACT.
Tools for Bringing Intimate
Partner Violence to Light.
October 13, 2011
SLO Vet’s Hall
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Women’s Shelter
Program of SLO County
serving victims of intimate partner violence &
child abuse
business phone: (805) 781-6401
fax: (805) 781-6410
crisis line: 781-6400
email: [email protected]
www. womensshelterslo.org
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Domestic Violence (DV)
Intimate Partner Violence (IPV)
A pattern of coercive behavior used by adults or
adolescents to control their partners involving
physical assault or the threat of it.
Types of Abuse
-- physical --- verbal --- emotional --- psychological --
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-- sexual --- economic --- spiritual --
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Statistics
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Over four million women are physically assaulted or raped in the
United States by a male intimate partner each year. Boys who
witness violence against their mothers are 10 times more likely to
abuse in adulthood than boys from non-violent homes. (CDC 2009)
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On average, a woman will leave an abusive relationship 7-9 times
before leaving permanently.
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Each year IPV results in… (California Disease Control, 2005)
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1,200 deaths and 2 million injuries among women
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nearly 600,000 injuries among men
DV & Children
(childwelfare.gov)
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3.3 million or more children witness domestic violence
each year
Children who live with DV face increased risks which
lead to negative outcomes and affect their well-being,
safety and stability
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Exposure to trauma
Neglect
Direct abuse
Losing one or both parents
Truths & Social Attitudes
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DV is not caused by drugs and alcohol
– 65% of DV cases have no substance abuse involved
– These are separate issues: DV is not about loss of control.
It’s about complete control.
DV is not caused by poverty
– DV crosses all socioeconomic, cultural and racial
boundaries
Why does she stay?
– Why does he abuse?
Possible Indicators
Physical indicators
Chronic
pain and /or areas
of tenderness especially at the
extremities
Bruises, welts, edema or
scars.
Swelling of eyes
Shoulder dislocation
Chronic headaches
Sexual assault
Signs of choking on throat
Split lip
Indirect indicators
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Depression
Addictions to prescription
medications, alcohol, and/or
illegal drugs
Symptoms of post traumatic
stress disorder
Suicide attempts
Isolation from friends and
family-only ties seem to be with
partner
Work absenteeism/lateness
Indirectly brings up the subject
of abuse.
Intervention
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Validating the adult victim’s experience:
– Avoid labeling the victim, but express concern.
– Raise concerns about danger.
– Explain cycle of violence and types of abuse.
– Empathize and validate victims feelings.
– Encourage victim to get help.
– Take a stand: “No one deserves to be abused.”
Drawbridge Exercise
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Take 3-5 minutes to complete
Discussion
San Luis Obispo County
Public Health
Department, Maternal
Child Adolescent Health
Program
Gina M. Pinto, MS, LMFT
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Intimate Partner
Violence
Why it is important to
ask about IPV?
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Statistics

Nearly 1 in 3 (31%) of American women
report being abused by an intimate
partner in their lifetime.
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In 66% of these incidents, an average of 2 children
are witness to the violence.
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Health Concerns Across a Woman’s Lifespan: 1998 Survey of Women’s Health. 1999. The
Commonwealth Fund. New York, NY.
Lewandowski, L., McFarlane, J., Campbell, J. C., Gary, F. & Barenski, C. (2004) He killed my mommy:
Children of murdered mothers. Journal of Family Violence, 19, 211 – 220.
Creating opportunities to have the
conversation:
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Always acknowledge client and others she
brings to her appointment. “So glad you are
here. Thank you for agreeing to meet/come
in.”
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Explain Limits of Confidentiality; equal
opportunity enforcement
Creating opportunities to have the
conversation cont’:
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Reference HIPAA, agency policies, and office
practices as reasons one on one time is required by
law.
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True consent can not be given in the presence of
other influences
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Private space is necessary
Preferably with a phone, for immediate referrals
How to Begin…
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“Because our office supports a safe haven for
people who may be experiencing situations where
violence, abuse or force is being used, we ask all
of our clients if they are in a safe living situation
and if they consider their relationships free of
abuse. That way, we can be a safe and supportive
place.”
Having the Conversation Matters
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Even when clients chose not to disclose, the
provider’s inquiry is often heard as supportive and
may contribute to future disclosure
IPV survivors report being asked and listened to
about their abuse was one of the most important
aspects of their interactions with their physician
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3 Hamberger LK, Ambuel B, Marbella A, Donze J. (1998). Physician interaction with battered women:
the women’s perspective. Archives of Family Medicine. Vol. 7, 575-582.
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Interviewer Comfort
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Importance of making IPV questions routine
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As you get to know your client, questions should be
meant to gather information in multiple realms, not
just IPV history
Remember to ask again at regular intervals
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Importance of using a non-judgmental tone
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Keep your body language open, empathic and respectful
Interviewer Comfort cont’
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Always remember to validate the client’s experience and
thank her for her disclosure
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Know what the local resources are and how to assist your
client in accessing them before you begin your interview
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Know your office policies and procedures
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Have key staff identified for assistance, as needed
(supervisor, medical director, etc.)
Interviewer Comfort cont’
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Continually check back in with your client
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“how are you feeling now?”
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“how can our office best support you?”
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“how are we (interviewer and client) doing?”
Interviewer Support: what do I do with
my feelings?
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Know when to ask for assistance from others on your
team
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Avoidance of the topic
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Find your thoughts wandering away from the tasks at hand
Seek support from your supervisor, other colleagues
or a professional as needed
Motivational Training
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Communication that is client centered, directive, and
targets behavior change.
Uses the following techniques:
- Open ended questions
- Reflection
- Affirmation
- Summarizing the plan and key questions
- Beware of traps
Open Ended Questions
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Invite many ways for a client to answer.
Closed questions can be answered with yes
or no.
Can you tell me what’s going on?
How is your family supportive?
Reflection
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This is a statement, not a question.
I hear you saying “this and that,” am I
understanding you correctly?
Affirmation
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Acknowledgement of difficulties, successes, skills,
and goals.
Commenting positively on an attribute: “You’re a
strong person, you are reaching out.”
Appreciation: “Thank you for your honesty.”
Compliment: “You’re a mom, you care about your
son.”
Expression of hope: “I hope this week goes well for
you.”
Summarize Plan & Key Questions
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It is important to check back in with the
client.
Summarize the conversation.
“Can I go over what we talked about?”
“How does this sound to you?”
Beware of Traps
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Expert trap
Question/Answer trap
Strength building
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Avoid victim blaming
Acknowledge survival strategies.
Build on strategies client has found successful in past
in avoiding harm to self and children.
Accept that an adult must find solutions with which
they can live. (cultural, religious, economic)
Opinions and solutions may change over time
Explore options
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What are the priorities for safety and basic
needs?
What has the client done in the past? How
well has that worked?
Break down tasks into manageable pieces.
Help client locate local support system.
Common Barriers to Seeking Help
and Hints to Help Victim Overcome Them
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Partner has threatened to kill victim
– DV shelters are confidential and exist nationwide
– Possibility of obtaining an Emergency Protective Order (EPO) and
a Temporary Restraining Order (TRO)
Partner will harm or abduct children
– In most circumstances children are welcome at DV shelters
– Legal protection of children through EPO’s, TRO’s, Good causes
and court mandated custody arrangement
Cont’
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Shelters are scary
 Does not want to
– Most shelters are very clean and safe
emotionally or legally
harmand
partner
– Domestic violence happens within all cultures
socioeconomic classes
– Many women are surprised about how supportive
andirony
normalizing the
– Present
shelter experience can be
– Many legal options are
– All DV shelters are temporary
voluntary when working
– Shelter staff are available to talk to over the with
phonea and
DV answer
shelterquestions at
any time
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Counseling options are
often available if the victim
is not ready to leave
When IPV is Reportable
California State Law, P C Section 11160
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When a client is receiving medical services for a
physical condition and is:
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Suffering from any wound or other physical injury, by his or
her own act, or inflicted by another, where the injury is by
means of a firearm and/or
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Suffering from any wound or other physical injury, that is
the result of assaultive or abusive conduct
When IPV is Reportable cont’
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Assaultive or Abusive Conduct Defined:
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Includes 24 criminal offenses, among which are murder,
manslaughter, torture, battery, sexual battery, incest,
assault with a deadly weapon, rape, spousal rape and abuse
of spouse or cohabitant. (California Penal Code section
11160-11163.6)
When IPV is Reportable cont’
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Domestic Violence Defined:
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Abuse committed against an adult or a minor who
is a spouse, former spouse, cohabitant, former
cohabitant, or person with whom the suspect has
had a child or is having or has had a dating or
engagement relationship
When IPV is Reportable cont’
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NOTE: If the patient reports that she was
abused in the past but there are no current
injuries, this is not a California Mandated
IPV Report, unless…
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If the past abuse was committed with children in
the environment. Then…
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A Suspected Child Abuse Report (SCAR) is Mandated
(see list of suspected child abuse mandated reporters as defined by CA law)
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When IPV is Reportable cont’
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When IPV is disclosed and
If the interviewer suspects that a minor Child was
present during the abuse incident, a Mandated
Suspected Child Abuse Report (SCAR, form #SS8572,
find on line at:
http://www.caag.state.ca.us/childabuse/pdf/ss
_8572.pdf)
must be phoned in as soon as possible (immediately),
and a written report is required to be filed within 36
hours
(see reference card in participant packet for online link)
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Questions/Clarifications?
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