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ASK. LISTEN. ACT. Tools for Bringing Intimate Partner Violence to Light.

ASK. LISTEN. ACT. Tools for Bringing Intimate Partner Violence to Light. October 13, 2011 SLO Vet’s Hall. Women’s Shelter Program of SLO County. serving victims of intimate partner violence & child abuse business phone: (805) 781-6401 fax: (805) 781-6410 crisis line: 781-6400

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ASK. LISTEN. ACT. Tools for Bringing Intimate Partner Violence to Light.

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  1. ASK. LISTEN. ACT. Tools for Bringing Intimate Partner Violence to Light. October 13, 2011 SLO Vet’s Hall

  2. Women’s Shelter Program of SLO County serving victims of intimate partner violence & child abuse business phone:(805) 781-6401 fax:(805) 781-6410 crisis line:781-6400 email:info@wspslo.com www. womensshelterslo.org

  3. A pattern of coercive behavior used by adults or adolescents to control their partners involving physical assault or the threat of it. Domestic Violence(DV)Intimate Partner Violence(IPV) Types of Abuse -- physical -- -- verbal -- -- emotional -- -- psychological -- -- sexual -- -- economic -- -- spiritual --

  4. Over four million women are physically assaulted or raped in the United States by a male intimate partner each year. Boys who witness violence against their mothers are 10 times more likely to abuse in adulthood than boys from non-violent homes. (CDC -2009) On average, a woman will leave an abusive relationship 7-9 times before leaving permanently. Each year IPV results in… (California Disease Control, 2005) 1,200 deaths and 2 million injuries among women nearly 600,000 injuries among men Statistics

  5. DV & Children (childwelfare.gov) 3.3 million or more children witness domestic violence each year Children who live with DV face increased risks which lead to negative outcomes and affect their well-being, safety and stability Exposure to trauma Neglect Direct abuse Losing one or both parents

  6. Truths & Social Attitudes DV is not caused by drugs and alcohol 65% of DV cases have no substance abuse involved These are separate issues: DV is not about loss of control. It’s about complete control. DV is not caused by poverty DV crosses all socioeconomic, cultural and racial boundaries Why does she stay? Why does he abuse?

  7. Chronic pain and /or areas of tenderness especially at the extremities Bruises, welts, edema or scars. Swelling of eyes Shoulder dislocation Chronic headaches Sexual assault Signs of choking on throat Split lip Indirect indicators Possible Indicators • Depression • Addictions to prescription medications, alcohol, and/or illegal drugs • Symptoms of post traumatic stress disorder • Suicide attempts • Isolation from friends and family-only ties seem to be with partner • Work absenteeism/lateness • Indirectly brings up the subject of abuse. Physical indicators

  8. Intervention • Validating the adult victim’s experience: • Avoid labeling the victim, but express concern. • Raise concerns about danger. • Explain cycle of violence and types of abuse. • Empathize and validate victims feelings. • Encourage victim to get help. • Take a stand: “No one deserves to be abused.”

  9. Drawbridge Exercise • Take 3-5 minutes to complete • Discussion

  10. San Luis Obispo County PublicHealth Department, Maternal Child Adolescent Health Program Gina M. Pinto, MS, LMFT

  11. Intimate Partner Violence Why it is important to ask about IPV?

  12. Statistics • Nearly 1 in 3 (31%) of American women report being abused by an intimate partner in their lifetime.1 • In 66% of these incidents, an average of 2 children are witness to the violence.2 • Health Concerns Across a Woman’s Lifespan: 1998 Survey of Women’s Health. 1999. The Commonwealth Fund. New York, NY. • Lewandowski, L., McFarlane, J., Campbell, J. C., Gary, F. & Barenski, C. (2004) He killed my mommy: Children of murdered mothers. Journal of Family Violence, 19, 211 – 220.

  13. Creating opportunities to have the conversation: • Always acknowledge client and others she brings to her appointment. “So glad you are here. Thank you for agreeing to meet/come in.” • Explain Limits of Confidentiality; equal opportunity enforcement

  14. Creating opportunities to have the conversation cont’: • Reference HIPAA, agency policies, and office practices as reasons one on one time is required by law. • True consent can not be given in the presence of other influences • Private space is necessary • Preferably with a phone, for immediate referrals

  15. How to Begin… • “Because our office supports a safe haven for people who may be experiencing situations where violence, abuse or force is being used, we ask all of our clients if they are in a safe living situation and if they consider their relationships free of abuse. That way, we can be a safe and supportive place.”

  16. Having the Conversation Matters • Even when clients chose not to disclose, the provider’s inquiry is often heard as supportive and may contribute to future disclosure • IPV survivors report being asked and listened to about their abuse was one of the most important aspects of their interactions with their physician3 3 Hamberger LK, Ambuel B, Marbella A, Donze J. (1998). Physician interaction with battered women: the women’s perspective. Archives of Family Medicine. Vol. 7, 575-582.

  17. Interviewer Comfort • Importance of making IPV questions routine • As you get to know your client, questions should be meant to gather information in multiple realms, not just IPV history • Remember to ask again at regular intervals • Importance of using a non-judgmental tone • Keep your body language open, empathic and respectful

  18. Interviewer Comfort cont’ • Always remember to validate the client’s experience and thank her for her disclosure • Know what the local resources are and how to assist your client in accessing them before you begin your interview • Know your office policies and procedures • Have key staff identified for assistance, as needed (supervisor, medical director, etc.)

  19. Interviewer Comfort cont’ • Continually check back in with your client • “how are you feeling now?” • “how can our office best support you?” • “how are we (interviewer and client) doing?”

  20. Interviewer Support: what do I do with my feelings? • Know when to ask for assistance from others on your team • Avoidance of the topic • Find your thoughts wandering away from the tasks at hand • Seek support from your supervisor, other colleagues or a professional as needed

  21. Motivational Training • Communication that is client centered, directive, and targets behavior change. • Uses the following techniques: - Open ended questions - Reflection - Affirmation - Summarizing the plan and key questions - Beware of traps

  22. Open Ended Questions • Invite many ways for a client to answer. • Closed questions can be answered with yes or no. • Can you tell me what’s going on? • How is your family supportive?

  23. Reflection • This is a statement, not a question. • I hear you saying “this and that,” am I understanding you correctly?

  24. Affirmation • Acknowledgement of difficulties, successes, skills, and goals. • Commenting positively on an attribute: “You’re a strong person, you are reaching out.” • Appreciation: “Thank you for your honesty.” • Compliment: “You’re a mom, you care about your son.” • Expression of hope: “I hope this week goes well for you.”

  25. Summarize Plan & Key Questions • It is important to check back in with the client. • Summarize the conversation. • “Can I go over what we talked about?” • “How does this sound to you?”

  26. Beware of Traps • Expert trap • Question/Answer trap

  27. Strength building • Avoid victim blaming • Acknowledge survival strategies. • Build on strategies client has found successful in past in avoiding harm to self and children. • Accept that an adult must find solutions with which they can live. (cultural, religious, economic) • Opinions and solutions may change over time

  28. Explore options What are the priorities for safety and basic needs? What has the client done in the past? How well has that worked? Break down tasks into manageable pieces. Help client locate local support system.

  29. Common Barriers to Seeking Help and Hints to Help Victim Overcome Them • Partner has threatened to kill victim • DV shelters are confidential and exist nationwide • Possibility of obtaining an Emergency Protective Order (EPO) and a Temporary Restraining Order (TRO) • Partner will harm or abduct children • In most circumstances children are welcome at DV shelters • Legal protection of children through EPO’s, TRO’s, Good causes and court mandated custody arrangement

  30. Does not want to emotionally or legally harm partner Present irony Many legal options are voluntary when working with a DV shelter Counseling options are often available if the victim is not ready to leave Cont’ • Shelters are scary • Most shelters are very clean and safe • Domestic violence happens within all cultures and socioeconomic classes • Many women are surprised about how supportive and normalizing the shelter experience can be • All DV shelters are temporary • Shelter staff are available to talk to over the phone and answer questions at any time

  31. When IPV is ReportableCalifornia State Law, P C Section 11160 • When a client is receiving medical services for a physical condition and is: • Suffering from any wound or other physical injury, by his or her own act, or inflicted by another, where the injury is by means of a firearm and/or • Suffering from any wound or other physical injury, that is the result of assaultive or abusive conduct

  32. When IPV is Reportable cont’ • Assaultive or Abusive Conduct Defined: • Includes 24 criminal offenses, among which are murder, manslaughter, torture, battery, sexual battery, incest, assault with a deadly weapon, rape, spousal rape and abuse of spouse or cohabitant. (California Penal Code section 11160-11163.6)

  33. When IPV is Reportable cont’ • Domestic Violence Defined: • Abuse committed against an adult or a minor who is a spouse, former spouse, cohabitant, former cohabitant, or person with whom the suspect has had a child or is having or has had a dating or engagement relationship

  34. When IPV is Reportable cont’ • NOTE: If the patient reports that she was abused in the past but there are no current injuries, this is not a California Mandated IPV Report, unless… • If the past abuse was committed with children in the environment. Then… • A Suspected Child Abuse Report (SCAR) is Mandated (see list of suspected child abuse mandated reporters as defined by CA law)

  35. When IPV is Reportable cont’ • When IPV is disclosed and • If the interviewer suspects that a minor Child was present during the abuse incident, a MandatedSuspected Child Abuse Report (SCAR, form #SS8572, find on line at: http://www.caag.state.ca.us/childabuse/pdf/ss_8572.pdf) must be phoned in as soon as possible (immediately), and a written report is required to be filed within 36 hours (see reference card in participant packet for online link)

  36. Questions/Clarifications?

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