Innovative Strategies for Dealing with Interpersonal Violence

1. Innovative Strategies for Dealing with Interpersonal Violence Phyllis W. Sharps, PhD, RN, FAAN Professor and Associate Dean for Community and Global Programs

2. Session Objectives 1. Discuss the importance of universal screening in maternal and child health care settings. 2. Identify barriers for screening and intervening. 3. Describe new strategies for screening and connecting families with resources for decreasing risks related to interpersonal violence.

3. VIOLENCE AGAINST WOMEN Across lifespan female children and women are more vulnerable Female victims of violence suffer significant health consequences Dynamics of violence against women is different compared to men

4. ALARMING STATISTICS • 1 in 3 women globally, have experienced some kind of assault: • Sexual • Physical • Psychological (UNFAP, 2000) • 1 in 4 women in USA report experiencing violence by a current or former partner (National Crime Victimization Survey: 2007-2008, US Dept. Justice, Bureau of Statistics – http://www.ojp.usdoj.gov/bjs/pub/pdf/cv07.pdf

5. ALARMING STATISTICS Women are much more likely to be victimized than men • Women = 84% of spouse abuse victims • Women = 86% of victims of abuse by BFs or GFs • 75% of perpetrators of family violence are male

6. ALARMING STATISTICS In the U.S., 32.7%of femicides were committed by intimate partner vs.3.1%male homicides were IPV-related (Fox & Zawitz, 2006) 50%of women who were victims of intimate homicide had been seen in the health care system in the year before their death(Langford, 1998; Sharps et al, 2002)

7. CDC NISVS Survey Results on IPV Victimization (weighted prevalence) Health Outcomes -2011

8. Cost Of Violence Against Women Cost of non-fatal injuries • 1995 = $5.8 M • 2012 = > $5.8 B Costsare • Direct medical/mental health care • Lost productivity from paid work & household duties – 13.6 M days of lost productivity

9. UNIVERSAL SCREENING It’s Important

10. UNIVERSAL SCREENING • Routine Screening & Brief Counseling mandated by 2012 Affordable Care Act – for primary care women’s health covered services • Recommended by 2011 IOM report (www.iom.edu) • Office of women’s health at DHHS (www.OWH.gov)

11. UNIVERSAL SCREENING USPTF 2013 recommends screening for IPV – ALL women of childbearing age (ACOG ’90 & ’13; Nursing Outlook ’13) Part of home visitation programs for pregnant women – DOVE intervention (Sharps, Bullock & Campbell NINR)

12. BARRIERS Challengesfor Screening and Intervening

13. PROVIDER CONCERNS Fear – asking might make it worst for women Personal safety – what if the abuser comes in or finds out! Fear – women and her children might not come back for care or drop –out of program Lack of training - not aware of all health care outcomes, myths, Frustrations – why do they stay, why they don’t use services Not sure – how to ask questions, what to say or do

14. WOMEN’S CONCERNS Embarrassment – to reveal Victimization – if abuser finds out What happens to my disclosure – who else knows Judgmental attitudes – of professionals and other helping professionals

15. STRATEGIES Screening and Intervening

16. Violence Against Women • Important Strategies • Universal Screening • Danger Assessment • Safety Planning • Referrals (shelters, legal)

17. Asking Questions Privacy Frame as routine part of practice Ask direct questions Ask at very visit Listen and be sensitive to her story Avoid minimizing her experience

18. Assessment Tools Abuse Assessment Screen (AAS) RADAR ASSERT

19. Abuse Assessment Screen 1. Have you ever been emotionally or physically abused by your partner or someone important to you? 2. Within the last year, have you been hit, slapped, kicked, pushed or shoved, or otherwise physically hurt by your partner or ex-partner? If YES, by whom Number of times 3. Does your partner ever force you into sex? 4. Are you afraid of your partner or ex-partner? Helton & McFarlane, 1986 Mark the area of any injury on body map.

20. Assessment Tools R:Remember to ask A:Ask directly D:Document findings A:Assess for safety R:Review options, refer (F:) Follow-up A:Ask S:Sympathize S:Safety E: Educate R:Refer T:Treat

21. Danger Assessment (Campbell ’86, 2001) Developed in 1985 to increase battered women’s ability to take care of themselves (Self Care Agency; Orem ‘81, 92) Modified – now 20 items - 2001 based on results from homicide study Interactive, uses calendar - aids recall plus women come to own conclusions - more persuasive & in adult learner/ strong woman/ survivor model Intended as lethality risk instrument versus re-assault (e.g. SARA, K-SID) - risk factors may overlap but not exactly the same

22. PROVIDER ROLES: ABUSE DURING PREGNANCY Routine assessment at EACH prenatal care visit by regular provider (McFarlane & Parker ‘92) If abuse during pregnancy, alert for child abuse Understand particular tendency for hope for relationship during pregnancy Careful assessment at post partum

23. One Love App – Danger Assessment APP for women aged 16-26 www.joinonelove.orgor www.dangerassessment.org Campbell et al JIPV 2009

24. “Coaching Boys Into Men” Futures Without Violence (www.futureswithoutviolence.org) Also Beyond Title Nine – Campus Violence; Start Strong; More!! RCT Miller et al, J of Adolescent Health 2012

25. Violence Against Women • Important Strategies • Coordinate Community Response • Integrated systems • Missed Opportunities • Empower Women • Listen to her story • Increase her awareness

26. Community Team Process Patient Survivors DV Advocates Legislative Military Physicians Prevention Intervention Treatment Society Education Social Services Governance Health Religious Nurse Professionals

27. NATIONAL DOMESTIC VIOLENCE HOTLINE1-800-799-SAFE (7233)

28. THANK YOU Phyllis W. Sharps, PhD, RN, FAAN psharps@son.jhmi.edu 410-614-5312