Domestic Abuse

SANE 2012

‘Probably the most important contribution to ending abuse and

protecting the health of its victims is to identify and acknowledge the abuse’

Council on Ethical and Judicial Affairs, American Medical Association

State Definition

According to S. C. Code of Laws Ann §16-25-20, “domestic violence” is defined as

• Causing physical harm or injury to a person’s household member;

• Offering or attempting to cause physical harm or injury to a person’s own household member with apparent present ability under circumstances reasonably creating fear of imminent peril.”

SC Stats

Domestic Violence FISCAL YEAR 2009 - 2010Number emergency shelters funded 13 programs with 18 shelters

Number Batterer Intervention Program Funded and Non-funded

8 Funded programs with 30 Non Funded programs

Number individuals receiving emergency shelter

3,192

Number women/children & men receiving myriad of services

19,850

Number of hotline calls 25,584

Number of approved Batterer Intervention Programs

38

Number of batterers receiving counseling services

3,295

Barriers

1) Lack of knowledge

2) Lack of Confidence in Intervention

3) Lack of time

THE VICTIMS

• Domestic violence happens between people who are dating, married, separated, and divorced.

• It occurs in heterosexual as well as in gay and lesbian relationships and in adolescent dating relationships.

Who are the VICTIMS?

Victims cross all socio-economic, religious, racial, ethnic, age groups

THE VICTIMS

StacyFirst American woman to summitMount Everest

“When people meet me, and find out that I’ve been in an abusive relationship…they just can’t believe it.”

“Looking at me, with all the things I’ve done in my life..They think, how could I have been in a relationship like that?”

THE VICTIMS• Women represent 95% of adult victims• Between 1 and 4 million women abused per

year• Lifetime risk for women is about 20%

THE VICTIMS

Domestic violence is the leading cause of injury to women ages 15-44 in the United States

THE VICTIMS

Research suggests DV results in more injuries to women requiring medical treatment than rape, auto accidents and muggings. (US Senate Judiciary Committee, 1992; Stark & Flitcraft, 1988)

THE VICTIMS

• Abused women comprise approximately 11-30% of women presenting with injury to hospital emergency services.

• Medical expenses from domestic violence total at least $3 to $5 billion annually.

DYNAMICS OFDOMESTIC VIOLENCE

POWER AND

CONTROL

Dynamics

• A pattern of assaultive and coercive behavior

– Physical– Sexual– Psychological

– threats– intimidation– emotional abuse– isolation

– Economic

DYNAMICS OFDYNAMICS OFDOMESTIC VIOLENCEDOMESTIC VIOLENCE

“Either dinner wasn’t exactly what he wanted, the house wasn’t immaculate, I didn’t look presentable enough… any excuse at all, really… and it was always my fault.”

“ It was very debilitating, I ended up walking on eggshells.I began questioning my own competence to do anything.”

THE DYNAMICS OF DOMESTIC VIOLENCE

• “It started out slowly. At first he just wanted to know where I was going all the time. Then he wanted to tell me where I was going all the time. By the end, I wasn’t allowed to go anywhere.”

• “If I went out with my girlfriends, I knew I would come back to find the house trashed… he would always break something he knew I really cared about.”

Who are theBATTERERS?

Batterers cross all socio-economic, Batterers cross all socio-economic, religious, racial, ethnic, age groupsreligious, racial, ethnic, age groups

Lundy Bancroft - Emerge

Characteristics of Batterers

Sense of EntitlementControllingManipulativeFrequently CharmingUninvolved parentShow contempt for others

THE BATTERERS• DV Is Learned Behavior by Batterers• DV Is NOT Caused By:– Illness– Genetics or gender– Alcohol or other drugs– Anger– Stress– Victim’s behavior– Relationship problems

What Makes Batterers So Powerful?

• Isolation of victim• Societal Denial• Use of Religious Issues• Use of Cultural Issues• Threats of Retaliation

THE CHILDRENPerpetrators of domestic violence

traumatize children

1. Physical InjuriesIntentionalUnintentional

2.Psychological InjuriesWitnessing Violence

THE CHILDREN

Effect on Children:

• In 85% of police calls for domestic violence, children had witnessed the violence

• Witnessing parental violence is a risk factor for:Males- to physically abuseFemales- to become victims of abuse

DOMESTIC VIOLENCE

Entry into the health care system represents an opportunity for detection of domestic violence and referral to appropriate community resources

DOMESTIC VIOLENCE and the Emergency Department

• 30% of all female trauma patients• 22-35% of all females presenting to the

Emergency Department• most are repeat ED patients

• 20% 11 or more abuse related visits• 23% 6-10 abuse related visits

DOMESTIC VIOLENCE SEQUELAE

In the 12 month period following violence:– Victims use health care services twice as

often as non-victims– Healthcare costs were 2.5 times higher for victims

Victimization was the single best predictor of

total yearly physician visits and of outpatient health care costs

FAILURE TO DIAGNOSE DOMESTIC VIOLENCE

• Inappropriate treatment• Increase victim’s sense of helplessness and

entrapment• Lost opportunity to refer to appropriate

community resources• Increase danger to the patient

Opening Pandora’s Box:Why physicians do not askpatients about domestic

violence#1 Not enough time -71%#2 Fear of offending the patient-55%#3 Powerlessness to intervene -50%#4 No control over patient behavior 42%#5 Too close for comfort -39%

What do I do if she says, “Yes?”

ACKNOWLEDGE - You Have Heard What the Patient Said

• Use supportive statements: “You don’t deserve this.” and, “Our concern is for your safety and your kids’ safety.”

• Affirm her autonomy and right to control decision-making.

What to do if she says, “Yes!”

The single most important thing you can dois to communicate the message

NO ONE DESERVES TO BE HURT LIKE THAT

REFER - Intervention With a Victim

• Be aware, materials and referrals you provide a victim may place her in danger

• Make a follow-up appointment

Why don’t they just leave?

FEAR

LOW SELF ESTEEM

ISOLATION

LACK OF RESOURCES

PROMISES TO CHANGE

FEAR SEPARATION VIOLENCE

• 73% of battered women seek emergency medical services after separation (Stark, 1981)

• Up to 75% of domestic assaults reported to police are made after separation (US Dept. of Justice, 1995)

• Women are most likely to be killed when attempting to report abuse or leave the abuser (Sonkin, 1985)

• Approximately one-half of males who kill their wives, do so after separation (Hart, 1992)

“Everyone seems to think that what you need to do is to just leave the relationship and then everything will be fine.”

That’s the myth. The reality is that the violence escalates if you try to get away.

“I knew that not only did I have to leave, I had to DISAPPEAR.”

FEARFEAR

“I thought that I was worthless, that I couldn’t do anything right.”

I thought I was ugly, just a horrible individual … no one would ever love me and I myself was incapable of love.”

LOW SELF ESTEEMLOW SELF ESTEEM

StacyFirst American Woman to summit Mount Everest

LEAVING IS A PROCESSLEAVING IS A PROCESS

“I think I left 12 times before I finally stayed gone.When I look back on it now, I realize I was practicing. It was a process… it took time, I had to learn how to leave and I had to learn how to stay gone.”

Promises to ChangePromises to Change

“I don’t really know why I kept going back...He begged me to, swore he’d never do it again.” “And, I wanted to hear it.I was overweight, I felt unloved…”

“After years of violence, I was completely bewildered. I didn’t know how to get away!”

There has to be a place to go to, its not just a matter of leaving from someone. And, for many victims of domestic violence that place either doesn’t exist or they don’t know that it exists.

LACK OF RESOURCESLACK OF RESOURCES

Leaving is a Process

• Safety Issues• Threats of Retaliation• Fear of Talking about Abuse to Others• Breaking Isolation• Access to Resources• Survival Strategies• Batterer Accountability

Leaving Is a Process

• SURVIVORS OF DOMESTIC VIOLENCE DO LEAVE!– They leave when they are ready– They leave when it is safe to do so– We can support their process by providing an

institutional response affirming battered women and their decision making ability

THE VICTIMS

Domestic violence is the leading cause of injury to women ages 15-44 in the United States

THE CHILDREN

‘Probably the most important contribution to ending abuse and

protecting the health of its victims is to identify and acknowledge the abuse’

Council on Ethical and Judicial Affairs, American Medical Association