A Public Health Issue. Boston Public Health Commission (BPHC). The Mission of the BPHC. is “. To protect, preserve, and promote the health and well-being of all Boston residents, particularly those who are most vulnerable. ID: 215459
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Intimate Partner Violence / Domestic ViolenceA Public Health IssueSlide2
Boston Public Health Commission (BPHC)
The Mission of the BPHC
To protect, preserve, and promote the health and well-being of all Boston residents, particularly those who are most vulnerable
Domestic Violence Program (DVP)
is one of about 30 BPHC programs, and was created in 1992 to address domestic violence as a serious public health problem. Our mission is to raise awareness of DV as a health issue in the City of Boston, and to support community efforts to address the problem.Slide3
Why is Domestic Violence a Public Health Issue?
It is prevalent in our society
It is a leading cause of injury and death, and has a serious impact on health
It affects the health of individuals, families, and the whole community
Some groups are at higher risk and have less access to help due to language, cultural, economic, physical, and other barriers
IPV/DV and its health effects are
What does it look like, sound like, feel like
of behaviors perpetrated in a private or family context intended to exert coercive control over another person, can include physical, sexual, psychological, and/or economic forms of abuse. in the context of a current or former intimate relationship.Slide6
Actual physical abuse and/orAn attempt to harm someone and/orPlacing someone in fear of serious physical harm and/or causing someone to engage in sexual relations by force, threat of force or duress.Economic and emotional abuse
The Massachusetts Abuse Prevention Act, Chapter 209 A, defines abuse as:Slide7
DV/IPV: The Data
Approximately 1.3 million women and 835,000 men are physically assaulted by an intimate partner annually in the US.
Patricia Tjaden & Nancy Thoennes, U.S. Dep't of Just., NCJ 183781,
Full Report of the Prevalence, Incidence, and Consequences of Intimate Partner Violence Against Women: Findings from the National Violence Against Women Survey, at iv
(2000), available at
2.2 million women physically assaulted by partner/ex- every year.
The Commonwealth Fund, 1999.
In a 1995-1996 study conducted in the 50 States and the District of Columbia, nearly 25% of women and 7.6% of men were raped and/or physically assaulted by a current or former spouse, cohabiting partner, or dating partner/acquaintance at some time in their lifetime
Patricia Tjaden & Nancy Thoennes, U.S. Dep't of Just., NCJ 181867,
Extent, Nature, and Consequences of Intimate Partner Violence, at iii (2000)
, available at
Boston Police Dept served over 2000 restraining orders in 2009Slide8
IPV - Epidemiology
25.5% lifetime prevalence (women)
7.6% lifetime prevalence (men)
Women overall at significantly greater risk than men and more likely to sustain injuries.
Women are significantly more likely than men to be injured during an assault: 31.5% of female rape victims, compared with 16.1% of male rape victims, reported being injured during their most recent rape, and 39-42% percent of female physical assault victims, compared with 20-25% of male physical assault victims, reported being injured during their most recent physical assault.
Most IPV victimizations never reported to police, especially those committed against menSlide9
DV/IPV deaths tripled between 2005 & 2007
2005 there were 15 murders and 4 suicides related to
2006, 28 murders and 3 suicides
2007, 42 murders and 13 suicides
2008, 28 murders, 1 suicide
2009, 22 murders, 5 suicides
2010, 32 murders, 12 suicides
32 murders, 2 suicides in Massachusetts this year – 10/11
(Jane Doe, Inc.)Slide10
Physical violence that increases in severity and frequency;
Abusive behaviors that are followed by apologies and promises of change;
Increased danger when the victim tries to leave.Slide11
IPV/DV is the abuse of power in a relationship
Individuals use various types of power/authority to harm/control another:
Verbal, Physical, Sexual, Emotional/Mental, Economic
Developed by: Domestic Abuse Intervention Project202 East Superior Street, Duluth, MN 55802218.722.4134
USING ECONOMIC ABUSE
Preventing you from getting or keeping a job;
Making you ask for money;
Giving you an allowance;
Taking your money;
Not giving you access to family income
Threatening to hurt or kill you; Threatening to leave you;
Threatening to commit suicide; Threatening to report you to welfare or immigration;
Making you drop charges;Making you do illegal things
USING INTIMIDATION Scaring you with looks, actions, or gestures;Smashing things, destroying your property, abusing pets;Displaying weapons;Using HIV status as a way to control you
USING EMOTIONAL ABUSE Putting you down;Making you feel bad about yourself;Calling you names;Making you think you’re crazy;Playing mind games;Humiliating you;Making you feel guilty
USING ISOLATION Controlling what you do, who you see and talk to, where you go;Withholding medical/social services, limiting outside activities;Using jealousy to justify actions
MINIMIZING, DENYING, AND BLAMING Making light of the abuse and not taking your concerns seriously;Saying the abuse didn’t happen;Blaming behavior on other things, like being drunk or under stress;Saying you caused the abuse
USING ENTITLEMENT Treating you as inferior because of your gender, race, education, religion, political views, sexual orientation, age, or physical characteristics;Not letting you make big decisions;Treating you like a servant
USING CHILDREN Making you feel guilty or responsible for children’s problems;Using children to relay messages or putting them in the middle of arguments;Threatening to take your children away, claim you are an unfit parent, or have you deported
PHYSICAL ABUSE INCLUDES... slapping, punching, choking, pinching, biting, shoving, burning, kicking, beating, stabbing, shooting
SEXUAL ABUSE INCLUDES...
forcing you to have sex or perform sexual acts you don’t like, refusing to practice safe sex, preventing you from using birth controlSlide14
IPV - Dynamics
Abuser tends to view ‘partner’ as inferior adversary, not as equal
Abusive behavior to gain compliance from, or control over another
Abuser may seem ‘healthier’ than survivor
Many perpetrators do not see their behavior as wrong in any waySlide15
Wave of Abuse
Hearts & Flowers
Same Old Stuff
Race, culture, community—intersections with ipv/dv
The ethnic/cultural background of the family may influence
The batterer’s tactics
The survivor’s coping strategies
The individual meaning of violence
The quality of the provider-client relationship
Shelter from the Storm, Child Witness to Violence Project, Boston Medical Center, 2000Slide17
Immigrant & refugee survivors’ fears
Worries, lack of knowledge, & misinformation about the legal system;
Kidnapping of children, loss of custody;
Harm to family at home
Losing connections with family/community here & in home countrySlide18
Working with immigrant & refugee survivors
Be clear about your role: what you can & will do, what you will not do (ie: contact INS);
Speak slowly, take your time;
Interview with the assistance of a bilingual, bicultural interpreter;
Do not use family members to translate.Slide19
Effects of domestic violence
Exacerbation of chronic complaints
Decreased attention to self-care, including difficulty maintaining medical and dietary regimens
Overall negative health effects, esp. with increased smoking, alcohol use.Slide20
Effects on victim
Fear for own safety & that of other family membersAnxiety/painAngerSense of shame & humiliationConfusion
Eating & sleep disruptions/disorders
Suicidal thoughts /attempts
High risk behaviors
Health Effects of Abuse
FATALHomicideSuicideMaternal mortalityAIDS relatedAny death resulting from issues at rightSource: Center for Health and Gender Equity
Physical injury, disability
Reproductive health problems
Negative health BehaviorsSlide22
Trauma in the lives of battered women
“Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning.”
The core of trauma is disconnection and disempowerment.
Herman J, 1990Slide23
Intimate Partner Violence during Pregnancy
Pregnancy can be an especially vulnerable time of life - Between 4% and 8% of women experience IPV during pregnancy, including women from all walks of life in every age, racial and ethnic group.
Experiencing IPV during pregnancy has been associated with pregnancy complications, pre-term labor, prematurity, low
infants, neonatal intensive care admissions and even neonatal death.
Among pregnant women, IPV is linked to depression, post-partum depression, eating an unhealthy diet and engaging in unhealthy behaviors, such as alcohol or drug abuse.Slide24
Intimate Partner Violence during Pregnancy
Partners may become abusive (or more abusive) during pregnancy because they feel:
upset over an unplanned pregnancy
increased stress at the thought of supporting a new baby (or an additional child)
jealous that a partner's attention may shift to the new baby (or a new relationship)Slide25
Potential Pathways of Co-occurrence(Adapted from the Institute For Health and Recovery “Working with Women with DV, MH and SA Problems”)
Mental Health Problems
Poverty/HomelessnessLow Self-esteemDependence on abuser
IPV - Barriers to Disclosure
Perceptions of health care system
Language, culture and religion
Abuser threats and controlSlide27
Mandatory Reporting Laws
State's mandatory reporting law & response to mandatory reports
If you suspect children are being neglected or harmed
Advocate on behalf of adult victim/survivor’s safety
If patient is over 65 or a dependent adultSlide28
Talking with clients is about dialogue, not simply screening
Only discuss domestic violence with client alone
Let the client know the limits of confidentiality
Use gender-neutral or gender-appropriate language
Prepare yourself for the client’s response
Recognize the client’s attachment to his/her partnerSlide30
Ways to Respond
I believe you.
I’m concerned about your safety.
No matter what your partner says, you don’t deserve to be treated this way.
I would like to give you the name and number of an advocate who is quite knowledgeable about these issues. (Can you safely carry this information home?)Slide31
Are there any weapons (or access to weapons) in the home?
Is there or has there ever been domestic violence?
Is there or has there ever been a Restraining Order filed against the client?
Is anyone in the home at risk of harm?
Are there any other safety concerns?Slide32
Client Safety:Immediate safety needs
Are you in immediate danger?
Where is the perpetrator now? Is he/she at this facility now?
Is it safe for you to go home?
Do you want the police or security to be notified?
Is it safe to take this written information with you?
Will it be safe for you to meet with advocates in the community or would you like to meet with them in one of our offices?Slide33
Client Safety: Pattern & History of Abuse
What was the most serious thing he/she ever did to you?
Has your partner forced you to have sex? Hurt you sexually? Forced you into sexual acts that made you uncomfortable?
Does your partner control what you do? Whom you see?Slide34
Client Safety:Additional risks to consider
Risks related to sexual violence
Risks related to self harmSlide35
Assess current access to advocacy and support resources
Has the client used community resources? Why? Why not?
How helpful were they?
What else does client need?Slide36
Listening to the client’s story, their experience, including their efforts to resist, seek help, and cope
Support the client with their struggle in their feelings/attachment to her partner
Consider their context: i.e. cultural, socio-economic, religious
Discuss immediate safety, developing plan which will be considered and modified in ongoing waySlide37
Validate client’s experiences;
Explore options/advocate for safety
Build on client’s strengths/avoid victim-blaming
Respect client’s right to make own decisionsSlide38
Success is NOT “fixing” DV or telling survivors what to do…
providing them an opportunity to talk to a trusted provider, get information, reduce isolation and increase options
Ensuring access to highest quality health care possibleSlide39
Massachusetts SafeLink DV Hotline - 877.785.2020
Boston Area Rape Crisis Center - 617.492.RAPE
National Domestic Violence Hotline: 1-800-799-SAFE (7233)
Domestic Abuse Helpline for Men & Women
1-888-7HELPLINE - spec. resources for men who are victimsSlide41
DV occurs around the world, in
countries, cultures, religious groups, and classes.
Around the world and in the US, about one out of three women has been physically or sexually assaulted by someone close to her in her lifetime.
DV occurs in same-sex as well as opposite-sex relationships.
Women are assaulted more frequently and are more seriously injured by the assaults than are men DV is a
of coercive control involving physical, sexual, psychological, and/or economic abuse.
DV is perpetrated in the context of a current or former intimate relationship.
DV is a learned behavior, chosen by the abuser b/c it works.
Cultural differences exist in how violence is perpetrated, how/when services are sought, etc.Slide42
IPV/DV is NOT…
an isolated incident
a random act of violence
a loss of control
caused by alcohol, drugs or stress
the victim’s fault
limited to physical assaultsSlide43
Defining Secondary Traumatic Stress
“…the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by another…the stress resulting from helping or wanting to help a traumatized or suffering person.”