Stop, Look, and ListenStop, Look, and Listen

Assessment of Domestic ViolenceAssessment of Domestic Violence

Emergency Medicine Review in the Rural and Emergency Medicine Review in the Rural and Urban SettingUrban SettingJune 10, 2007June 10, 2007

Kathy Bell MS, RNKathy Bell MS, RN

… Ask me.

I’d have told them everything, I swear to God I would have. If they’d asked. I’d have whispered it. If they’d asked first. He pulled my arm behind my back and lifted me off the floor. It would have been easy after that, watching them listen. He hit me. He burned me. He did it. He did it. Save me. I’d have told them everything. I just had to be brought behind the curtain, asked the right question. ….

Screening in Oklahoma Screening in Oklahoma

35% of 61 respondents queried 35% of 61 respondents queried reported that a health care provider reported that a health care provider had asked them about domestic had asked them about domestic violence some, most, or all of the violence some, most, or all of the time when treated for IPV injuries; time when treated for IPV injuries; 65% had never been asked about 65% had never been asked about domestic violence by a health care domestic violence by a health care provider when treated for IPV provider when treated for IPV injuries.injuries.

When not to screen When not to screen

If the provider cannot secure a If the provider cannot secure a private space private space

If there are concerns that screening If there are concerns that screening the patient is unsafe for either the the patient is unsafe for either the patient or the providerpatient or the provider

When children ages 3-12 are present.When children ages 3-12 are present. If the provider is unable to obtain an If the provider is unable to obtain an

appropriate interpreter appropriate interpreter

Salber and Taliaferro 2006

They have a choice.They have a choice.What might happen?? What might happen??

StayStay

KiKilledled InjuryInjury

• Physical Physical • Emotional

Child abuseChild abuse Lose childrenLose children Modeling behavior Modeling behavior

to childrento children SuicideSuicide DepressionDepression

PovertyPoverty Loss of:Loss of:

• CredibilityCredibility• FamilyFamily• FriendsFriends• JobJob• SelfSelf

Health Health • Physical Physical • MentalMental

‘Staying’ implies that the person is in some way inviting, allowing, or tolerating the abuse rather than acknowledging that women are

resisting the abuse all the time in ways that are generally invisible to people

outside of their situation. It also implies that the woman’s ‘staying’ is at the heart of the problem rather than the

abuser’s behavior toward her.

LeaveLeave

KiKilledled InjuryInjury

• Physical Physical • Emotional

Child abuseChild abuse Lose childrenLose children Modeling behavior Modeling behavior

to childrento children SuicideSuicide DepressionDepression

PovertyPoverty Loss of:Loss of:

• CredibilityCredibility• FamilyFamily• FriendsFriends• JobJob• SelfSelf

Health Health • Physical Physical • MentalMental

Leaving’ implies that someone can leave an abuser like they would leave an apartment they choose not to rent anymore, while the reality is that leaving an abuser is

extremely difficult. A perpetrator of domestic abuse seeks to maintain control over their partner and children – even after their partner leaves. Having children creates a legal bond between parents that often provides the framework for ongoing abuse after separation. Rarely do abusers

disappear or victims relocate and change their identities. In the common reality of abused women, the men who

abuse them continue to intersect with their lives in a variety of ways: living in the same town, working for the same

employer, visitation with children, friends in common, etc.

Challenges in the communityChallenges in the community

Lack of real alternatives for Lack of real alternatives for employment and financial assistanceemployment and financial assistance

  Lack of affordable legal assistance to Lack of affordable legal assistance to obtain a divorce, custody order, or obtain a divorce, custody order, or permanent protection from abuse orderpermanent protection from abuse order

Limited availability of subsidized Limited availability of subsidized housing and lack of public housing and lack of public transportation, particularly in rural transportation, particularly in rural communitiescommunities

Challenges continuedChallenges continued

The structure of family law, which The structure of family law, which approaches parental rights and approaches parental rights and responsibilities with the presumption responsibilities with the presumption that joint custody is best, and that that joint custody is best, and that spouse abuse is an exception that spouse abuse is an exception that requires careful proof.requires careful proof.

  Public disdain for single parentsPublic disdain for single parents   Lack of affordable childcare and Lack of affordable childcare and

health carehealth care

Domestic Violence Nurse Examiner Domestic Violence Nurse Examiner ProgramProgram

On-Site Partners Domestic Violence Intervention Services

• DVIS/Call Rape Advocates • DVIS legal services

RSVP Safety Shepherd Volunteers Tulsa County DA office Tulsa County Sheriff Office Tulsa Metropolitan Ministries Tulsa Police Department

• Family Violence Unit• Forensic Nurse

YWCA of Tulsa Multicultural Center

Services

AdvocatesAdvocates Chaplain ServicesChaplain Services CounselingCounseling District Attorneys OfficeDistrict Attorneys Office Forensic NursesForensic Nurses Lawyers for Family MattersLawyers for Family Matters Law EnforcementLaw Enforcement

Additional Services

Children’s play area Interpretation services Referral for children Referral to immigration services Referral to shelter services Safety and prevention education

0 8 25 53 78 78 55 47 43 30 35 28

480

28 2800

508

0

100

200

300

400

500

600

Month

No. o

f Clie

nts

2006 2007 2008 2009 Total to date

AssessmentAssessment

PhysicalPhysicalEmotional Emotional SocialSocial

DocumentationDocumentation Danger AssessmentDanger Assessment Safety PlanningSafety Planning ReferralReferral PhotographyPhotography Evidence collectionEvidence collection