Domestic Violence
Dr. Dawn-Elise Snipes, PhD, LMHC
Objectives
~ Review the extent of the problem
~ Identify risk factors for violence
~ Review practice guidelines for working with survivors of DV
~ Identify primary, secondary and tertiary interventions
~ Explore components of an effective routine DV screening program
Statistics
~ 2-4 million women battered each year
~ 20-30% lifetime risk for a woman to be battered
~ 1,500 women murdered/year by partners
~ 20-30% of women seen in medical setting may be abuse victims
~ 5-6% prevalence of elder mistreatment (1.8 million)
~ 1,100 childhood deaths from abuse each year
~ 140,000 childhood injuries from abuse each year
~ 1.7 million reports of child abuse each year
~ 250,000-450,000 cases of child sexual abuse/year
~ 16 percent of adult women report a history of sexual abuse by a family member
Economic Costs
Acute medical care for injuries or neglect, and their complications
~ medical complications from injuries with enduring effects
~ mental health and substance abuse care for victims, perpetrators and families
~ inappropriate medical care for unrecognized mental health problems (“distressed high utilizers”)
Criminal justice system
~ intervening, arrests, prosecution, incarceration, etc.
Legal system
~ separation, divorce, custody disputes, protection orders, etc.
Social welfare organizations
~ emergency shelters, housing, foster care, etc.
Impediments to work
~ absenteeism or poor productivity
Practice Guidelines
~ Implement routine, universal screening
~ in all health care settings
~ for all females 12 years of age and older
~ Skills to foster an environment that facilitates disclosure:
~ how to ask the question
~ how to respond
~ what to document
~ your legal obligations
~ Screening strategies and initial responses
~ respond to the needs of all women
~ take into account differences based on diversity
~ Use reflective practice to examine how your own beliefs, values, and experiences influence the practice of screening
Educational Guidelines
~ Mandatory educational programs in the workplace designed to increase:
~ knowledge and skills
~ foster awareness and sensitivity about abuse
~ Curricula incorporate content on abuse in a systematic manner
Organizational Recommendations
Develop policies and procedures
~ supporting routine universal screening & initial response
Work with the community at a systems level to improve collaboration and integration of services between sectors
Practice implementation requires:
~ adequate planning, resources, administrative support
~ appropriate facilitation
~ an assessment of organizational readiness and barriers
~ involvement of all members
~ dedication of a qualified single point of contact
~ ongoing opportunities for discussion and education
~ opportunities for reflection
Definition
~ Woman abuse is:
~ the intentional and systematic use of tactics to establish and maintain power and control over the thoughts, beliefs and conduct of a woman through the inducement of fear and/or dependency
~ The tactics include:
~ emotional, financial, physical and sexual abuse, as well as, intimidation, isolation, threats, using the children and using social status and privilege
Primary Prevention
~ Prevents disorders before they occur
~ May include such activities as:
~ educating patients about the domestic violence
~ teaching parents about appropriate discipline
~ educating children about respect and appropriate assertiveness
~ recognizing and referring patients at-risk for perpetrating abuse
~ assessing potentially over-s