Healthcare and Domestic Violence in Arkansas

Angela McGraw, CVAP-A

The Arkansas Coalition Against Domestic Violence

ACADV Mission Statement

The mission of the Arkansas Coalition Against Domestic Violence is to eliminate domestic violence and promote healthy

families. 

Training Topics

Prevalence of Domestic Violence or IPV Arkansas Law Causes of Domestic Violence Understanding Domestic Violence

Perpetrators & Victims Impact of IPV on Adults and Children Implications for the Health Care Practice Questions

Prevalence of Intimate Partner Violence (IPV)

Family Violence is Very Common:

[1] 4.8 million women experience IPV related physical assaults & rapes.

[2] Men are the victims of about 2.9 million IPV related physical assaults.

[3] Two-thirds of women have been raped, physically assaulted, or stalked by a current or former husband, cohabiting partner, boyfriend, or date.

Prevalence of Intimate Partner Violence (IPV)

Family Violence is Very Common:

[4] Based on findings from the Bureau of Justice Statistics' National Crime Victimization Survey of 2003: 54 percent of violence against males was conducted by strangers, while 64 percent of violence against females was conducted by nonstrangers.

IPV victims turn to their health care system:1. 1st attempt to get help is from health care

providers.

a. legal or battered women’s services

b. individual or cultural issues

2. Community services assist victims in accessing health care providers.

Coordinated Community Response

1. Dynamics of IPV Include:a. Nature of the problem & its impact on health

b. Causes

c. Perpetrators

d. Victims

Coordinated Community Response

2. Cultural contexts of both domestic violence & health care.

3. Misunderstanding of one or more of these issues decreases our effectiveness with our patients.

CASE STUDY

What is Domestic Violence?Domestic Violence is any abusive, violent,

coercive, forceful, or threatening act of word inflicted by one member of a family

of household on another.

Arkansas State Law

Arkansas Code Title 9: Family Law: Chapter 15: Domestic Abuse: Subsection 103: Definitions. (9-15-103)

"Domestic abuse" means:

(A) Physical harm, bodily injury, assault, or the infliction of fear of imminent physical harm, bodily injury, or assault between family or household members; or

(B) Any sexual conduct between family or household members, whether minors or adults, which constitutes a crime under the laws of this state;

Arkansas State Law

(3) "Family or household members" means spouses, former spouses, parents and children, persons related by blood within the fourth degree of consanguinity, any children residing in the household, persons who presently or in the past have resided or cohabited together, persons who have or have had a child in common, and persons who are presently or in the past have been in a dating relationship together; and

Arkansas State Law

4)(A) "Dating relationship" means a romantic or intimate social relationship between two (2) individuals which shall be determined by examining the following factors: (i) The length of the relationship; (ii) The type of the relationship; and (iii) The frequency of interaction between the two (2) individuals involved in the relationship. (B) "Dating relationship" shall not include a casual relationship or ordinary fraternization between two (2) individuals in a business or social context.

Enhancement Penalties

In the presence of children; means in the physical presence of child or knowing or having reason to know that child is present and may see or hear act.

Offenses against pregnant women.

Definitions. (12-12-107) A health care provider may report to a law

enforcement agency an injury to an adult that the health care provider has reason to believe is the result of a battery or other physically abusive conduct, including physical injuries resulting from domestic violence, if the Injured adult agrees; or Health care provider determines that the report is

necessary to prevent serious harm to the injured adult.

A health care provider shall promptly inform the injured adult that the report has been or will be made.

Laws Affecting Children

Act 944 (2003)An act to enhance the penalty for offenses of domestic violence committed on a pregnant woman.

(A woman is considered pregnant 4 weeks after conception)

Abusive Behaviors List

Physical Sexual Psychological Use of economics Use of children to control an adult victim

Effects of IPVPhase 1: Tension Building

Batterer behavior Picks fights Acts jealous and possessive Criticize or threaten Drink and/or uses drugs Moody and unpredictable

Victim behavior Feels like walking on eggshells Tries to reason with batterer Tries to calm batterer Tries to appease batterer Keeps silent and tries to keep children silent Feels anxious or afraid

Assault

TensionHoney-moon

Effects of IPVPhase 2: Crisis/Assault

Batterer behavior Verbal and physical

abuse Sexual and emotional

assault Increased control over money and partner Destroys property

Victim behavior Feels fear and shock Protects self and children Uses self-defense Calls for help Tries to leave Prays for it to stop Does what is necessary

to survive

Assault

Honeymoon

Tension

Effects of IPVPhase 3: Honeymoon

Batterer behavior Asks for forgiveness Promises it won’t happen

again Stops drinking and using

drugs Goes to counseling Affectionate Minimizes or denies

abuse

Victim behavior Forgives Returns home Arranges for counseling Feels hopeful Feels manipulated Blames self Minimizes or denies

abuse

ACTIVITY

CAUSES OF IPV

They have solved their problems in the past with violence They have effectively exerted control and power over others through violence No one has stopped them from being violent in the past

Causes of IPV

IPV is learned in the family, in communities, & in society.

www.myspace.com/video/beatriz/children-imitate...parents/10715169

IPV is Not Caused by:

Genetics Illness Alcohol and/or drugs Stress and/or Anger Out of control behavior Behavior of the victim or problems in the

relationship

Understanding IPV Perpetrators & VictimsA. Individual experience with IPV

Experience with IPV Sensitivity to stereotypes Behavioral definition of IPV– how to use it in

assessing IPV

ACTIVITY

I will ask you a series of questions, which I want you to answer just by a show of hands.

ACTIVITY

1. Using the behavioral definition of IPV, answer the following questions. How many of you, in your role as a health

care provider, have talked with a victim of IPV about the abuse?

How many of you, as a health care provider, have talked with a IPV perpetrator about the abuse?

ACTIVITY

2. Using the behavioral definition again,

answer these questions: How many of you, in your nonwork

interactions have talked with a victim of IPV about the abuse?

How many have talked in that nonwork world with a IPV perpetrator about the abuse?

ACTIVITY

3. This time I do not want you to raise your

hand…do not raise your hands…sit on

your hands…and just answer these

questions for yourself: Using the behavioral definition of IPV, how

many of you are victims/survivors of IPV? How many of you are perpetrators?

Understanding IPV Perpetrators & Victims

B. Influence of Prior Experience with IPV on Current Work with Patients

Perpetrators

A. Perpetrators come from all groups

B. Gender

C. Minimizing, denying, or lying

D. Coercive tactics by using the health care provider

Victims

A. The primary victim: The intimate partner 1. Gender

2. Demographics

3. Why they stay

4. Victims’ various presentation in health care settings (next slide)

5. Goal/Support

34

Abused women experience a

Campbell et al, 2002

50% to 70% increasein gynecological, central nervous system, and stress-related problems

IMPLICATIONS FOR WOMEN’S HEALTH

IPV is a hidden risk factor for many common women’s health problems

Screening provides an opportunity for women to make the connection between victimization, health problems, and risk behaviors

35

-woman at crisis center

Wilson et al, 2007

IMPLICATIONS FOR WOMEN’S HEALTH

Cancelled and missed appointments, interrupted care and noncompliance with treatment and follow-up may be related to

victimization.

Victims

A. The primary victim: The intimate partner 1. Gender

2. Demographics

3. Why they stay

4. Victims’ various presentation in health care settings (next slide)

5. Goal/Support

Victims

B. The forgotten victims: The children Victim’s may be accompanied by children or

the patient may be the children. Perpetrator’s use of children – physical,

emotional, & behavioral effects

Victims

C. Other victims: Those trying to help or innocent bystanders

Module 5 – Effects of Domestic Violence

Implications for the Health Care PracticeA. IPV can be lethal and is a major health issue.

B. Guiding principles for the health care response to IPV victims:

1. Safety for victims & their children

2. Respect the rights for self-determination

3. Holding perpetrators responsible for violence

4. Advocate on behalf of victims

5. Individual practice & health care system

Implications for the Health Care PracticeC. Elements of an improved health care response to

domestic violence victims:

1. Screen

2. Assess

3. Intervention giving validating messages providing information safety planning referring follow-up

Implications for the Health Care PracticeC. Elements of an improved health care response

to IPV:

4. Document

REMINDER:

Role of the Health Care Provider•R – Remember to ask routinely about violence•A - Ask Questions•D – Document Findings•A – Assess Patient’s Safety•R – Review Options

Failure to Identify IPV

Results in: Incorrect diagnosis Costly & inappropriate tests Ongoing morbidity and mortality

IPV Is A Health Concern

[5] The national health care costs of IPV are high, with direct medical and mental health care services for victims amounting to nearly $4.1 billion.

[6] Among women admitted to an emergency room for violence-related injuries, 37 percent were abused by an intimate partner.

IPV Is A Health Concern

[7] In a study on the effects of violence, women who experienced any type of violence or abuse were significantly more likely to report being in “fair or poor” health, and were almost twice as likely to be coping with some form of depression.

IPV Is A Health Concern

[8] One study found that women who had experienced any type of personal violence (even when the last episode was 14 to 30 years ago) reported a greater number of chronic physical symptoms than those who had not been abused. The risk of suffering from six or more chronic physical symptoms increased with the number of forms of violence experienced.

[9] Although 96 percent of patients believe physicians should inquire about family conflict, two-thirds report that their physician has never asked them about intimate partner violence. Sixty-seven percent of those whose physician has inquired about family conflict reported that the same physician helped them receive assistance.

IPV Is A Health Concern Homicide

Homicide was the second leading cause of death on the job for women in 2003, according to the Bureau of Labor Statistics.

Fifteen percent (15%) of the 119 workplace homicides of women in that year were attributed to a current or former husband or boyfriend.

[10] Spouses, boyfriends/girlfriends and ex-boyfriends/ex-girlfriends were responsible for the on-the-job deaths of 321 women and 38 men from 1997-2009, according to the U.S. Department of Labor, Bureau of Labor Statistics.

IPV Costs Employers

The Centers for Disease Control and Prevention estimates that the cost of intimate partner rape, physical assault and stalking totaled $5.8 billion each year for direct medical and mental health care services and lost productivity from paid work and household chores.

WOMEN WHO TALKED TO THEIR HEALTH CARE PROVIDER ABOUT THE ABUSE WERE:

~4 times more likely to use an intervention 2.6 times more likely to exit the abusive relationship

McCloskey et al, 2006

RESOURCE

Download at: http://www.cdc.gov/ncipc/pub-res/images/ipvandsvscreening.pdf

Basile et al, 2007

References:

[1][2] Department of Health & Human Services. Preventing Intimate Partner & Sexual Violence. Accessed May 16, 2012. [3] Catalano, S.M. Criminal Victimization, 2003 : Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics,

2004, NCJ 205455. [4] National Association of Crime Victim Compensation Boards. Compensation to Victims Continues to Increase Exit Notice.

Accessed March 14, 2007. [5] U.S. Dept. of Health and Human Services, National Center for Injury Prevention and Control. March, 2003. Costs of

Intimate Partner Violence Against Women in the United States. Atlanta, GA: Centers for Disease Control and Prevention. [6] U.S. Department of Justice, Bureau of Justice Statistics. (1997). Violence Related Injuries Treated in Hospital

Emergency Departments, Special Report. [7] Collins, K., Schoen, C., Joseph, S, Duchon, L. Simantov, E. & Yellowitz, M. (1999). Health Concerns Across A Woman's

Lifespan: The Commonwealth Fund 1998 Survey of Women's Health.  [8] Christina Nicolaidis et al., 2004, “Violence, Mental Health, and Physical Symptoms in an Academic Internal Medicine

Practice,” Journal of General Internal Medicine 19, 81523. Retrieved October 5, 2009. [9] Sandra K. Burge et al., 2005, “Patients’ Advice to Physicians about Intervening in Family Court,” Annals of Family

Medicine 3, 3. [10] U.S. Department of Labor, Bureau of Labor Statistics. 2010. Occupational Homicides by Selected Characteristics,

1997-2009. Available at: http://www.bls.gov/iif/oshwc/cfoi/work_hom.pdf Max, W, Rice, DP, Finkelstein, E, Bardwell, R, Leadbetter, S. 2004. The Economic Toll of Intimate Partner Violence Against

Women in the United States. Violence and Victims, 19(3) 259-272. Costs of Intimate Partner Violence Against Women in the United States. Centers for Disease Control and Prevention,

National Center for Injury Prevention and Control. 2009.

Questions?

Angela McGrawEducation Coordinator

Arkansas Coalition Against Domestic Violence(501)907-5612

amcgraw@domesticpeace.comWebsite: www.domesticpeace.com