innovative strategies for dealing with interpersonal violence phyllis w. sharps, phd, rn, faan...
TRANSCRIPT
Innovative Strategies for Dealing with
Interpersonal Violence Phyllis W. Sharps, PhD, RN, FAAN
Professor andAssociate Dean for Community and Global
Programs
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.
Session Objectives
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
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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
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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
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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)
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CDC NISVS Survey Results on IPV Victimization (weighted prevalence) Health Outcomes -2011
Disproportionately higher among AI/AN, African American & Multiracial Womenwww.cdc.gov/ViolencePrevention/NISVS
Females lifetime
Females Past Year
Males Lifetime
Males Past Year
Physical violence 32.9 4 28.2 4.7
Rape 9.4 .6 * *
Stalking 10.7 2.8 2.1 .5
Rape, physical violence, &/or stalking
35.6 5.9 28.5 5
With IPV-related impact (fear, PTSD Sx, Injury, pregnancy, STI, missed work, need for services)
28.8 - 9.9 -
Severe physical violence (vs. push/shove/slap)
24.3 2.7 13.8 2
Any psychological aggression (expressive or coercive control)
48.8 13.9 48.4 18.1
Injury/needed medical care from IPV
*Cell size too small or standard error too large
14.8/7.9
4/1.6
Cost Of Violence Against Women
Cost of non-fatal injuries 1995 = $5.8 M 2012 = > $5.8 BCosts are Direct medical/mental
health care Lost productivity from
paid work & household duties – 13.6 M days of lost productivity 8
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It’s Important
UNIVERSAL SCREENING
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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)
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)
UNIVERSAL SCREENING
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Challenges for Screening and Intervening
BARRIERS
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
PROVIDER CONCERNS
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Embarrassment – to reveal
Victimization – if abuser finds out
What happens to my disclosure – who else knows
Judgmental attitudes – of professionals and other helping professionals
WOMEN’S CONCERNS
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Screening and Intervening
STRATEGIES
Important Strategies Universal Screening Danger Assessment Safety Planning Referrals (shelters, legal)
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Violence Against Women
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
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Asking Questions
Abuse Assessment Screen (AAS)
RADAR
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Assessment Tools
Abuse Assessment ScreenAbuse 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.
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Assessment Tools
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R: Remember to askA: Ask directlyD: Document findingsA: Assess for safetyR: Review options, refer (F:) Follow-up
A: Ask S: SympathizeS: SafetyE: EducateR: ReferT: Treat
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
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Danger Assessment (Campbell ’86, 2001)
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 partum22
PROVIDER ROLES: ABUSE DURING PREGNANCY
One Love App – Danger Assessment APP for women aged 16-26
www.joinonelove.org or www.dangerassessment.org
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Campbell et al JIPV 2009
“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
Important Strategies Coordinate Community Response Integrated systems Missed Opportunities
Empower Women Listen to her story Increase her awareness
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Violence Against Women
Patient Survivors DV Advocates
Legislative Military PhysiciansPreventionInterventionTreatment
Society Education Social Services
Governance Health Religious NurseProfessionals
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Community Team Process
NATIONAL DOMESTIC VIOLENCE HOTLINE
1-800-799-SAFE (7233)
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Phyllis W. Sharps, PhD, RN, FAAN
410-614-5312
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THANK YOU