Intimate Partner Violence / Domestic Violence

Intimate Partner Violence / Domestic ViolenceA 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

.”

The

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.

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

preventable

!!

What does it look like, sound like, feel like

Exercise

IPV/DV Defined

A

pattern

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.

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

Legal Definition:

The Massachusetts Abuse Prevention Act, Chapter 209 A, defines abuse as:

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

http://www.ojp.usdoj.gov/nij/pubs-sum/183781.htm

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

http://www.ojp.usdoj.gov/nij/pubs-sum/181867.htm

Boston Police Dept served over 2000 restraining orders in 2009

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 men

Commonwealth Homicides

DV/IPV deaths tripled between 2005 & 2007

2005 there were 15 murders and 4 suicides related to

ipv

/

dv

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.)

IPV/DV includes:

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.

IPV/DV is the abuse of power in a relationship

Individuals use various types of power/authority to harm/control another:

Gender

Racial/ethnic identity

Socioeconomic status

Educational level

Class privilege

Sexual orientation

Verbal, Physical, Sexual, Emotional/Mental, Economic

Exercise

DA

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

USING COERCION

AND THREATS

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

POWERAndCONTROL

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 control

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 way

Wave of Abuse

Abusive Incident

Remorse

Hearts & Flowers

Same Old Stuff

Carping

Abusive Incident

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

Community response

Institutional response

The individual meaning of violence

The quality of the provider-client relationship

Shelter from the Storm, Child Witness to Violence Project, Boston Medical Center, 2000

Immigrant & refugee survivors’ fears

Deportation;

Worries, lack of knowledge, & misinformation about the legal system;

Kidnapping of children, loss of custody;

Finances;

Harm to family at home

Losing connections with family/community here & in home country

Working with immigrant & refugee survivors

Be clear about your role: what you can & will do, what you will not do (ie: contact INS);

Listen carefully;

Speak slowly, take your time;

Interview with the assistance of a bilingual, bicultural interpreter;

Do not use family members to translate.

Effects of domestic violence

Traumatic injury

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.

Effects on victim

Fear for own safety & that of other family membersAnxiety/painAngerSense of shame & humiliationConfusion

Depression

Eating & sleep disruptions/disorders

Suicidal thoughts /attempts

High risk behaviors

Hypervigilance

Health Effects of Abuse

FATALHomicideSuicideMaternal mortalityAIDS relatedAny death resulting from issues at rightSource: Center for Health and Gender Equity

NON-FATAL

Physical injury, disability

Chronic conditions

Mental Illness

Reproductive health problems

Negative health Behaviors

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, 1990

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

birthweight

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.

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)

Potential Pathways of Co-occurrence(Adapted from the Institute For Health and Recovery “Working with Women with DV, MH and SA Problems”)

Victimization

Physical, Financial,

Mental Health Problems

Self-MedicationUnhealthy coping

Addiction

Poverty/HomelessnessLow Self-esteemDependence on abuser

Perpetration,

Illegal activity,

Incarceration

Trauma sequelae

IPV - Barriers to Disclosure

Fear

Perceptions of health care system

Language, culture and religion

Immigration status

Sexual orientation

Abuser threats and control

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 adult

The Conversation

Talking with clients is about dialogue, not simply screening

Only discuss domestic violence with client alone

Let the client know the limits of confidentiality

Discuss documentation

The Conversation

Use gender-neutral or gender-appropriate language

Prepare yourself for the client’s response

Recognize the client’s attachment to his/her partner

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?)

Safety Assessment

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?

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?

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?

Client Safety:Additional risks to consider

Partner risks

Risks related to sexual violence

Risks related to self harm

Client Safety

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?

Advocacy

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 way

Empowerment

Validate client’s experiences;

Explore options/advocate for safety

Build on client’s strengths/avoid victim-blaming

Respect client’s right to make own decisions

Defining Success

Success is NOT “fixing” DV or telling survivors what to do…

Success IS

providing them an opportunity to talk to a trusted provider, get information, reduce isolation and increase options

Ensuring access to highest quality health care possible

Employers

Criminal Justice

Other communityresponses

Faith Community

DV/SA Programs

Health Care

24-hr hotlines

Massachusetts SafeLink DV Hotline - 877.785.2020

877.521.2601 (TTY)

Boston Area Rape Crisis Center - 617.492.RAPE

617.492.6434 (TTY)

National Domestic Violence Hotline: 1-800-799-SAFE (7233)

800.787.3224 (TTY)

Domestic Abuse Helpline for Men & Women

1-888-7HELPLINE - spec. resources for men who are victims

IPV/DV Facts

DV occurs around the world, in

all

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

pattern

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.

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

genetic

limited to physical assaults

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.”

Figley 1995

STAND UP