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Intimate Partner Violence

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					        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: info@wspslo.com
                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 --                 -- sexual --
      -- emotional --              -- economic --
    -- psychological --             -- spiritual --


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        Statistics

         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)

         On average, a woman will leave an abusive relationship 7-9 times
          before leaving permanently.

          Each year IPV results in… (California Disease Control, 2005)
         –    1,200 deaths and 2 million injuries among women
         –    nearly 600,000 injuries among men




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    DV & Children
    (childwelfare.gov)




        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
          –   Exposure to trauma
          –   Neglect
          –   Direct abuse
          –   Losing one or both parents




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    Truths & Social Attitudes


        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?




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    Possible Indicators

      Physical indicators                  Indirect indicators
     Chronic   pain and /or areas        Depression
     of tenderness especially at the      Addictions to prescription
     extremities                           medications, alcohol, and/or
     Bruises, welts, edema or             illegal drugs
     scars.
                                          Symptoms of post traumatic
     Swelling of eyes                     stress disorder
     Shoulder dislocation
                                          Suicide attempts
     Chronic headaches
                                          Isolation from friends and
     Sexual assault                       family-only ties seem to be with
     Signs of choking on throat           partner
     Split lip                           Work absenteeism/lateness
                                          Indirectly brings up the subject
                                           of abuse.
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    Intervention

       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.”




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     Drawbridge Exercise

        Take 3-5 minutes to complete
        Discussion




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     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.                        1




        In 66% of these incidents, an average of 2 children
         are witness to the violence.                           2




     1   Health Concerns Across a Woman’s Lifespan: 1998 Survey of Women’s Health. 1999. The
         Commonwealth Fund. New York, NY.
     2   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.




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     Creating opportunities to have the
     conversation:


        Always acknowledge client and others she
         brings to her appointment. “So glad you are
         here. Thank you for agreeing to meet/come
         in.”

        Explain Limits of Confidentiality; equal
         opportunity enforcement
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     Creating opportunities to have the
     conversation cont’:

        Reference HIPAA, agency policies, and office
         practices as reasons one on one time is required by
         law.

        True consent can not be given in the presence of
         other influences

         –   Private space is necessary
         –   Preferably with a phone, for immediate referrals


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     How to Begin…



      –   “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.”


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     Having the Conversation Matters


        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                                         3




           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

        Importance of making IPV questions routine

         –   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

        Importance of using a non-judgmental tone

        Keep your body language open, empathic and respectful

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     Interviewer Comfort cont’

        Always remember to validate the client’s experience and
         thank her for her disclosure

        Know what the local resources are and how to assist your
         client in accessing them before you begin your interview

        Know your office policies and procedures

        Have key staff identified for assistance, as needed
         (supervisor, medical director, etc.)

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     Interviewer Comfort cont’


        Continually check back in with your client

         –   “how are you feeling now?”

         –   “how can our office best support you?”

         –   “how are we (interviewer and client) doing?”

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     Interviewer Support: what do I do with
     my feelings?


        Know when to ask for assistance from others on your
         team

         –   Avoidance of the topic

         –   Find your thoughts wandering away from the tasks at hand


        Seek support from your supervisor, other colleagues
         or a professional as needed


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     Motivational Training

        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

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     Open Ended Questions

        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?




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     Reflection

        This is a statement, not a question.
        I hear you saying “this and that,” am I
         understanding you correctly?




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     Affirmation

        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.”

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     Summarize Plan & Key Questions

        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?”




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     Beware of Traps

        Expert trap
        Question/Answer trap




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     Strength building

        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



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     Explore options

        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.



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     Common Barriers to Seeking Help
     and Hints to Help Victim Overcome Them


        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




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     Cont’

        Shelters are scary                         Does not want to
          – Most shelters are very clean and safe      emotionally or legally
                                                       harm partner
          – Domestic violence happens within all cultures and socioeconomic classes
                                                        – Present irony
          – Many women are surprised about how supportive and normalizing the
            shelter experience can be                   – Many legal options are
          – All DV shelters are temporary                   voluntary when working
                                                            phone DV shelter
          – Shelter staff are available to talk to over the with a and answer questions at
            any time
                                                      –   Counseling options are
                                                          often available if the victim
                                                          is not ready to leave




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     When IPV is Reportable
     California State Law, P C Section 11160



        When a client is receiving medical services for a
         physical condition and is:

         –   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

         –   Suffering from any wound or other physical injury, that is
             the result of assaultive or abusive conduct



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     When IPV is Reportable cont’

        Assaultive or Abusive Conduct Defined:

         –   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)




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     When IPV is Reportable cont’

        Domestic Violence Defined:
         –   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




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     When IPV is Reportable cont’

        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…
         –   If the past abuse was committed with children in
             the environment. Then…
                 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’

        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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