DOVE, Inc. is committed to serving communities,families and individuals impacted by domestic violence.We seek to empower our clients and the community byproviding safety, shelter, education and support services.By promoting an environment free from abuse, we strive to seeDOmestic Violence Ended.

Shelter ProgramFounded 34 years ago18 beds

families, singles, childrenmen/women/transgender

Victims are accepted regardless of gender or sexual orientation

Visiting Nurse and CounselorSupport Groups24 hour HotlineIndividual Advocate Meetings

Community Advocacy Serving clients in the communitySupport groupsIndividual advocacy & counselingLegal AdvocatesCourt Outreach ProgramCivilian DV AdvocateSexual Assault counselorOutreach

Teen Dating Violence PreventionEducational Workshops

U.S. Preventive Services Task Force The USPSTF recommends that clinicians screen women of

childbearing age for intimate partner violence, such as domestic violence, and provide or refer women who screen positive to intervention services. This recommendation applies to women who do not have signs or symptoms of abuse.

Affordable Care Act  Screening and counseling for interpersonal and domestic violence

will be covered for all adolescent and adult women. An estimated 25% of women in the United States report being targets of intimate partner violence during their lifetimes. Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women.

Patient Satisfaction increased when asked about DV

Why are we here?

Impact on HealthIn addition to injuries sustained during

violent episodes, physical and psychological abuse are linked to a number of adverse physical health effects including arthritis, chronic neck or back pain, migraine and other frequent headaches, stammering, problems seeing, sexually transmitted infections, chronic pelvic pain, and stomach ulcers.

Coker, A., Smith, P., Bethea, L., King, M., McKeown, R. 2000. “Physical Health Consequences of Physical and

Psychological Intimate Partner Violence.” Archives of Family Medicine. 9

Definition of Domestic ViolenceDomestic Violence also known as battering, is a pattern of

behavior used to establish power and control over a partner, friend or any other person through fear and intimidation, often including the threat or use of violence. While the violence may cause injury, it does not have to be physical. Domestic Violence also takes the form of emotional verbal sexual and economic abuse.

Domestic Violence affects people of all ethnic, racial and economic backgrounds. It affects women, men, and transgendered people. It takes place in same sex relationships as well as heterosexual relationships.

Battering happens when one person believes that they are entitled to control another. Assault, battering, and domestic violence are crimes”.

Definition taken from the National Coalition Against Domestic Violence and Jane Doe Inc.

StatisticsGirls and women between the ages of 16 and

24 experience the highest rates of DV and sexual assault

Relationship violence is the number one cause of injury to women ages 15-44: more than rapes, muggings, and car accidents combined.

Every day at least 3 women are murdered by their husbands or boyfriends in this country.

1 in 4 GLBT people are battered by a partner at some point in their lives.

*Statistics from the US dept of justice, Center for disease control and Prevention, Center for Community Solutions, American Psychological Association, and the Bureau of Justice Statistics Special Report

Health Care CostsThe Centers for Disease Control and

Prevention estimates that the cost of intimate partner rape, physical assault and stalking totaled $5.8 billion each year for direct medical and mental health care services and lost productivity from paid work and household chores.

Costs of Intimate Partner Violence Against Women in the United States. Centers for Disease Control and

Prevention, National Center for Injury Prevention and Control. 2003. Available at

http://www.cdc.gov/violenceprevention/pdf/IPVBook-a.pdf.

Max, W, Rice, DP, Finkelstein, E, Bardwell, R, Leadbetter, S. 2004. The Economic Toll of Intimate Partner

Violence Against Women in the United States. Violence and Victims, 19(3) 259-272.

Health Care CostsOf this total, nearly $4.1 billion are for direct

medical and mental health care services and productivity losses account for nearly $1.8 billion in the United States in 1995. When updated to 2003 dollars, the cost is more than $8.3 billion.

Costs of Intimate Partner Violence Against Women in the United States. Centers for Disease Control and

Prevention, National Center for Injury Prevention and Control. 2003. Available at

http://www.cdc.gov/violenceprevention/pdf/IPVBook-a.pdf.

Max, W, Rice, DP, Finkelstein, E, Bardwell, R, Leadbetter, S. 2004. The Economic Toll of Intimate Partner

Violence Against Women in the United States. Violence and Victims, 19(3) 259-272.

In One Day2011 National Census of Domestic

Violence Services1,799 Victims of DV accessed an array of

services in MA 788 found shelter 1,011 benefitted from individual counseling,

legal advocacy and support groups 596 hotline calls

25 calls every hour 479 unmet needs due to shortage of funds and

staff for housing, mental health counseling and legal representation

(national Network to End Domestic Violence, 2011)

5 Types of Abuse

PhysicalFinancialEmotional/Mental/PsychologicalVerbalSexual

Physical AbuseSlapping/ PunchingKickingSpittingPinchingPushing/ShovingBitingUse of weaponsThrowing objectsThrowing person down stairsChoking/ strangulationDenial of physical needs; sleep, food, medical attention

FinancialRefusing partner access to money for

food, clothing and basic needsControlling all assets (car & house)Putting all the bills in the partners nameRunning up chargesRuining credit

VerbalThreats such as ‘You’ll be sorry’, ‘I’m

going to let you have it’Threats to disclose information about

partner that is confidential (such as past abuse)

Yelling, screamingSwearing, name calling

SexualManipulationGuilt trippingCoercingForcing degrading sexual actsComments like whore or slutExposing selfPenetrationJokes or insultsUnwanted touching or groping

Emotional/ Mental/ PsychologicalContinued attacks on self esteemRepeated harassing InterrogatingDegradationThreats to withhold moneyTake childrenHave an affair InsultsControllingForcing to stay awakeBlaming for all the goes wrong Isolation

MythsMental IllnessLow self esteemSubstance abuseAnger managementProvocationExternal stressors

FACT: ABUSE IS A CHOICE

Screening for DVOld screening question :

Do you feel safe at home?

New screening questions: open ended, behavioralHow are things at home?Has your partner ever hit, kicked, shoved or

punched you?Does your partner put you down? Have you ever felt afraid of your partner?

How to AskScreen the patient for IPV aloneUse your own words, ask questions in a

supportive and non judgmental mannerAsk direct, simple and behaviorally specific

questionsAsk about their ‘partners’ as opposed to

‘husband’ or ‘spouse’Don’t use terms like ‘battered’ or ‘abused’ Show compassion and understanding for

people’s choices

Normalizing the Question“Because abuse and violence are so common

in people's lives, I have begun to routinely ask about abuse.”

“I do not know if this has ever been a problem for you, but because so many women I see are dealing with abusive relationships I've started asking about it routinely.”

Normalizing the Question“We now know that violence affects many

families. Violence in the home may result in physical and emotional problems for you and your child. We are offering services to anyone who may be concerned about violence in their home.”

“Because there is help available for women who are being abused, I now ask every woman about DV.”

Time ConcernsIt takes 6-10 seconds to frame the issue

and ask a screening questionApproximately 85% of patients will screen

negative for IPV You have let the patient know that this is an

important health issue and your office is willing to help if needed

Taliaferro, E., Surprenant, Z. Medical Directions, 2006. Respond to Intimate Partner Violence; 10 Action Steps you can take to help your patients and your practice.

Time ConcernsIt takes 2-3 minutes to deal with most

patients who screen positively for IPVAbout 14% will give a positive response

Most will be in ‘stable IPV’ (non urgent)Provide rapid assessment of immediate

safety

Will take longer to help the > 1% that respond positively and have urgent needs

Taliaferro, E., Surprenant, Z. Medical Directions, 2006. Respond to Intimate Partner Violence; 10 Action Steps you can take to help your patients and your practice.

Follow up QuestionsAt minimum, ask some of the following:

Are you afraid your life may be in danger?Do you feel safe at home with your partner?Do you have somewhere safe to go?Has there been an escalation in the violence?Have weapons or threats been used?Has your partner choked or strangled you?Do you know what to do if the situation

becomes dangerous (call 911, have safety plan)

Responding to Disclosures“I disclosed when someone appeared to care about the answer.” - patient

“I’m glad you told me. We see many other patients in similar situations. No one deserves to be abused. I want to connect you with someone to talk to.” - doctor

Red Flags An injury/event that is inconsistent with the

client’s history (I fell playing a sport)A changing, inconsistent history or vague

description of the cause of an injury/eventMinimization of the injury/eventA delay in seeking care for significant

medical conditions

Red Flags Missed or canceled appointments

Partner canceling Unusual behavior between patient and

partnerSuggestive trauma patterns

Multiple visits to ER, injuries in various states of healing, defensive wounds

If a Patient does not EngageUse indirect statements and questions when a

patient has denied IPV, but you feel it is a possibilityI am asking you this because I am concerned about

your safetyAre you having problems with your partner? Do your

arguments ever become physical? Are you ever afraid? Have you ever gotten hurt?

You seem concerned about your partner. Can you tell me more about that?

You mentioned your partner uses alcohol. How do they act when they become intoxicated? Does their behavior frighten you?

If a Patient does not EngageGoal is NOT disclosureGoal is to create a culture of SUPPORT

When should screening occurDuring new patient examsAnnuallyDuring episodic visits, if indicators are

presentWhen patient enters new intimate

relationshipIf patient is pregnant, once a trimester and

during postpartumFamily planning visits, STI visits, abortion

clinics, fertility clinic visits

High Risk IndicatorsHistory of Violence/ Past AssaultsThreats to kill (partner, child, pet)Access or use of weaponsObsessive jealously and/or preoccupation

with partnerStalking or monitoring partnerStrangulationForced Sex

Risk to the VictimStay-Physical injury-Death-Physical or psychological harm to children-Loss of children-Loss of income/job-Loss of family, friends and support-Loss or damage to possessions

Leave-Physical injury-Death-Physical or psychological harm to children-Loss of children-Loss of income/job-Loss of family, friends and support-Loss or damage to possessions

Victim Blaming Statements Clients May Hear

Did you try to stop the abuse?What did you do to provoke it?Why don’t you just leave?It can’t be that bad.If someone treated me like that I know I

would just leave.That happened a while ago, can’t you just

forget about it?He would never do that (don’t believe the

victim).

RecapCreate a safe place to discloseSupport patientRefer to outside services

AwarenessInformation

Posters “ Let us know, we can help”RestroomsExam roomOnlineHealth Ed ClassesEngaged and informed workforce

In practiceDomestic Violence work is based on models

which uphold client’s right to self determination

Safety PlanningEducationOptionsResources

CLIENT IS EXPERT

Contact InformationCrisis Hotline 617 471 1234 Community Office 617 770 4065Safelink 1 877 785 2020

All services are free and confidential

www.dovema.orgwww.janedoe.org