Week 5: Discussion, Summary & Reflection

yazmillie13

IntimatePartnerViolenceAdvocacy.ppt

Home >Psychology homework help >Week 5: Discussion, Summary & Reflection

Hasmik Chakaryan

Teaching counselors advocacy for intimate partner violence victims and survivors

Domestic Violence:
DV is a pattern of abusive and coercive behaviors, including physical, sexual, and psychological attacks, as well as economic coercion, that adults or adolescents use against their intimate partners. (ODVN)
Physical and/or emotional abuse comprises any form of violence that causes bodily harm, pain, assault, isolation, deprivation, and psychache.
Intimate Partner Violence
IPV is a serious, preventable public health problem that affects millions of Americans. The term "intimate partner violence" describes physical, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy. IPV can vary in frequency and severity. It occurs on a continuum, ranging from one hit that may or may not impact the victim to chronic, severe battering. (CDC)
Domestic violence and IPV are often used interchangeably.

DEFINITIONS

One in four women will be victims of domestic abuse in their lifetimes.
1.3 million women are victims of physical assault by an intimate partner every year!
1/3rd of female homicide victims are killed by an intimate partner
The cost of domestic violence exceeds $5.8 billion each year
Domestic violence is one of the most chronically underreported crimes
¼ of physical assaults, 1/5th of all rapes, and ½ of stalkings committed by an intimate partner are reported to the police.

Because the prevalence of female victims is much higher, as statistics indicate, we are going to address the problem of Intimate Partner Violence with a focus on female victims in this presentation. However, this in no way undermines the fact that men also become victims of IPV.

DOMESTIC VIOLENCE IN THE UNITED STATES

Missouri Statistics 2012
Nearly 19,000 turned away from full shelters
42,484 adults, youth and children received

domestic violence services

25,016 requests for services were unmet

due to a lack of resources

95 percent of those aided by domestic violence

programs said it enhanced their safety and

knowledge of community resources

STATISTICS

By a show of hands, how many of you have received specific domestic violence training?
By a show of hands, how many of you have had a client affected by domestic violence?
See the difference?

Barriers to Detection of DV exist due to the lack of professionals’ knowledge, preparation, confidence in skills and time

ARE WE EDUCATED TO SERVE THISPOPULATION?

It is estimated that as few as 3% of cases are actually reported.
The highest prevalence of domestic violence cases occurs within community clinics and emergency departments.
The mental and physical health consequences are so severe, yet there is no published domestic violence screening protocols for behavioral health care providers.
What does this mean? There is no best practice in detecting domestic violence, but it is estimated that domestic violence effects 1.5 to 4 million people annually in the United States.

Are we educated to serve this population?

What does domestic violence look like?

DV Is the Systematic Pattern of Intentional Intimidation Through the Use of Threats and Violence for the Purpose of Gaining Power and Control Over One’s Partner in an intimate relationship

THE POWER AND CONTROL WHEEL

CYCLE OF VIOLENCE

Physically-- broken bones, facial and neurological trauma, cardiovascular and gastrointestinal conditions, injuries to head, neck, chest, breasts and abdomen, as well as injuries during pregnancy (abuse during pregnancy has twice the prevalence of toxemia)

What happens to the woman?

Psychiatric Symptoms
Most commonly
Depression
PTSD; Panic Attacks
Suicidal ideation/attempts
Sleep disorders
Eating disorders
Addiction
BWS (Battered Woman Syndrome) as formed by Lenore Walker

Physiological Symptoms
Neck to thigh
Injuries can be hidden
Indicates abuser is in control
Visible injuries
Sign of escalating abuse
Indicate abuser is out of control

Other possible symptoms: Premenstrual syndrome and painful periods, Chest pain, Morning stiffness, Cognitive or memory impairment, Numbness and tingling sensations, muscle twitching, swollen extremities, & skin sensitivities, Dizziness and impaired coordination

Six Symptoms
The victim re-experiences the battering if it is occurring again. The images and feelings are real to them.
The victim attempts to avoid the psychological impact of battering by avoiding activities, people, and emotions. They ignore the ways of their old life in attempt to make all the negative feelings go away.
Hyperarousal or hypervigilance
Disrupted personal relationships
Body image distortions or other somatic concerns (migraines)
Sexuality and intimacy issues are present

Battered Woman Syndrome

Limited access to routine and/or emergency medical care
Noncompliance with treatment regime
Not being allowed to obtain or take medication
Missed appointments
Frequent accidents
Lack of independent transportation, access to finances, ability to communicate by phone
Failure to use condoms or other contraceptives
Partner is not told that he/she is infected with HIV or other sexually transmitted diseases
Partner accompanies the patient, insists on staying close, and answers all questions directed to victim
Reluctance of a patient to speak or disagree in front of partner
Intense irrational jealousy or possessiveness expressed by partner or reported by patient
Denial or minimization of violence by partner or patient
Exaggerated sense of personal responsibility for relationship, including self-blame for violence

The following indicate a lack of control in a relationship and should trigger the provider to consider domestic violence

Laughing – “tittering”
No eye contact
Crying
Sighing
Minimizing statements
Searching – engaging eye contact (fear)
Anger - defensiveness

Behaviors Suggestive of Abuse

Anxious body language
Standing to leave
Drooped shoulders
Depressed
Comments about emotional abuse
Comments about a “friend” who is abused

NEVER have anyone in room when screening. This could put the client in immediate danger.
Multiple scales exist
Composite Abuse Scale -- Measures four dimensions of domestic violence including physical abuse, emotional abuse, combined abuse, and harassment
Conflicts Tactic Scale – Longer, rates negotiation, psychological aggression, physical assault, sexual coercion, and injury
HITS Scale – Mostly used by family doctors. Assesses hurt, insult, threaten, and scream
Women’s Experience with Battering Scale– Ten question survey assessing feelings associated with battering.

Screen for Domestic Violence

Do you mean in cases of in-home or couple’s counseling?

By using the Domestic Violence Survivor Assessment (DVSA), a counselor can see what areas they need to focus on in treatment and how far they have come in treatment.
The DVSA modifies the change stages into committed to continuing the relationship, committed but questioning, considering change: abuse and options, breaking away, and establishing a new life.
Using this assessment will aid the counselor in seeing what stage the client is in for different dimensions. These dimensions include attachment, seeking legal sanctions, triggers, views of relationship, accessing help, self-identity, and feelings.

How can we assess it?

Demographics

Anyone can be a perpetrator or victim of domestic violence, regardless of their:

Race/ethnicity
Class
Education/occupation
Age
Physical ability
Sexual orientation
Personality traits
It is vital that the counselors are culturally sensitive to the diverse population of IPV, educate themselves about the specific cultural components of their clients, ask questions to learn from their clients, practice non-judgmental attitude and patience while working with victims and survivors.

MULTICULTURAL SENSITIVITY

Most importantly provide:
Immediate safety
Privacy
Prompt medical and psychological assessment
Supportive, non-judgmental environment

Before any specific treatment is agreed upon

Caring, empathetic questions may open the door for later disclosure

Ask questions in private - apart from male partner; - apart from family or friends

Explain issues of confidentiality

Be aware of mandatory reporting laws in your state and inform the woman of them

Fear, embarrassment/shame, mistrust, dependence on perpetrator, lack of support system may cause victims to answer no to the questions asked by the professional.

INTERVENTIONS

Is anyone in your family hitting you?

Has anyone hit you while you were pregnant?

Have you ever received medical treatment for any abuse injuries?

Does your partner ever threaten you?

Does your partner prevent you from leaving the house, getting a job, or returning to school?

What happens when your partner doesn’t get his/her way?

Does your partner threaten to hurt you when you disagree with him/her?

Does your partner destroy things that you care about like family photographs, clothes, pets?

Are you forced to engage in sex that makes you feel uncomfortable?

Do you have to have intercourse after a fight to make up?

Does your partner watch your every move?

Does your partner call home ten times a day?

Does your partner accuse you of having affairs with everyone?

Do you know where you could go or who could help you if you were abused or worried about abuse?

The following assailant behaviors, especially in a cluster, should lead the provider to warn the victim and see that he/she has a safety plan:
Abuser has history, threats, or fantasies of homicide or suicide attempts
Depression and situational stresses, such as job loss
Weapons possession or past use of weapons
Rage over the victim leaving
Obsession about partner (“I can’t live without him/her”) and her centrality to the batterer’s life (Is the batterer so isolated that loss of victim represents a sense of hopelessness?)
Drug/alcohol consumption in state of fury and depression
Access to the battered individual
Continually hunting down and harassing victim
Escalation of the abuser’s threats and violence

LETHALITY ASSESSMENT

Empower the victim, validating her abuse and affirming that

This is not her fault

No one deserves to be treated this way

Does she want to talk about it?

Acknowledge that it is frightening, humiliating and painful to be hit.
Let victim know you have an emotional and intellectual response to the abuse.
The first step toward ending an abusive relationship is for victim to feel it is intolerable.
Be specific and immediate in your suggestions
Where are you going to stay tonight?
Are you and children safe for the next 24 hours?
How can you get money?

PROVIDING RESPONSE

Your concern for her (and her children’) safety

Help is available to her. Begin providing further interventions as applicable.

The IPV victim is the one who will choose when and how much to disclose. Give her back her right to make choices.
Don’t feel overwhelmed, frustrated and impatient when she chooses not to disclose, not to leave her abusive partner, not to move out or anything else that you find are best options for her.
She is ultimately the one in the situation and knows best what is safer for her. She needs your support and empowerment in whatever choice she makes.
Be aware of coping and defense mechanisms that victims may utilize.
Do not make assumptions: every situation is distinct and unique. Validate that.
Give her resources she can choose from when she is ready. Help her come up with a plan for either case: staying or leaving.

EMPOWER THE VICTIM

Shelters, housing, food stamps, hotlines, legal options, etc.

Leaving your house safely (statistics show that perpetrators’ violence increases when victim shows signs of leaving and they are more likely to use more lethal methods to remain in control. Stalking and homicidal behaviors become more prevalent)
Extra copy of house and car keys
Develop a code word
Copy important documents & prepare a bag to give to a trusted person
Use your instincts and judgment when it is safe and the best time to leave
Dial 911 in emergency
Suggest victim prepare a “natural disaster” or “hurricane” bag to keep available.
Keep in easily accessible location
Include birth certificates, immunization records, pet records, medications, bank information, important belongings

SAFETY PLANNING

Can money be hidden for emergency use?

Can victim run to neighbor’s house or work out a signal so neighbor calls the police?

How can healthcare provider safely call victim? How should provider identify self? What should provider do if batterer answers phone?

If victim moves, should prevent abuser from finding him/her by making long distance calls from different phone, asking agencies/schools not to reveal address.

Clinical records can be subpoenaed. Obtain legal consultation.
Keep records concise, brief and report clinically significant information exactly as shared by the client
Document
Physical evidence
Verbal statements
Photographs (with consent)
Body map showing injuries
Complex psychosocial stressors
Be aware of all resources available to the IPV victims and to the professional for consultation and guidance.
http://www.mocadsv.org/Publications.aspx

DOCUMENTATION AND REPORTING

National resources for victims of domestic violence:

National Domestic Violence Hotline

(800) 799-SAFE (7233) / (800) 787-3224 (TTY) (http://www.ndvh.org)

National Coalition Against Domestic Violence

(303) 839-1852 (http://www.ncadv.org)

National Resources for Health Care Professionals

National Health Resources Center on Domestic Violence

(415) 678-5500 (http://www.endabuse.org/health)

USE YOUR CLINICAL JUDGMENT

Apply RADAR

Routinely screen every patient
Ask directly, kindly, nonjudgmentally
Document your findings
Assess the patient’s safety
Review options and provide referrals

(Massachusetts Medical Society, 1992)

Domestic Silence revisited: Abuse victims lacking shelter? (2012). The Columbus Dispatch. Retrieved from http://www.dispatch.com/content/stories/local/2011/11/27/lacking-shelter.html
Ohio Domestic Violence Network. (2012). Retrieved from http://www.odvn.org/
Centers for Disease Control and Prevention. (2012). Retrieved from http://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html
Dienemann, J., Campbell, J., Landenburger, K., & Curry, M. (2002). The domestic violence survivor assessment: A tool for counseling women in intimate partner violence relationships. Patient Education and Counseling, 46, 221-228.
Dienemann, J., Glass, N., Hanson, G., & Lunsford, K. (2007). The domestic violence survivor assessment (dvsa): A tool for individual counseling with women experiencing intimate partner violence. Issues in Mental Health Nursing, 28, 913-925.
Domestic Violence Facts. (2007, July). Retrieved from http://www.ncadv.org/files/DomesticViolenceFactSheet(National).pdf
Hamberger, K.L. & Phelan, M.B. (2004). Domestic Violence Screening and Intervention in Medical and Mental Healthcare Settings. New York, NY: Springer Publishing Company, Inc.
Howard, L., Trevillion, K., & Agnew-Davies, R. (2010). Domestic violence and mental health. International Review of Psychiatry, 22(5), 525-534.
Matevia, M. L., Goldman, W., McCulloch, J., Randall, P.K. (2002). Best Practices: Detection of Intimate-Partner Violence Among Members of a Managed Behavioral Health Organization. Psychiatric Services. 3(5), 555-557.
Massachusetts Medical Society. (1992). Massachusetts Medical Society
Punukollu, M. (2003). Domestic violence: Screening made practical. Journal of Family Practice, 52(7), 537-543.
Walker, L. (1980). The battered woman. New York, NY: Harper & Row Publishers, Inc.

Resources