Power and Control
- Coercion and Threats
- Intimidation Making and/or carrying out threats Making her afraid by using looks, to hurt or leave partner, commit actions, gestures, smashing things, suicide, report her to welfare, destroying her property, abusing making her do illegal things, pets, displaying weapons, and making her drop charges. target practice.
- Economic Abuse
- Emotional Abuse Putting her down, making her feel keeping a job, making her work bad about herself, calling her and taking her money, making names, making her think she’s her ask for money, giving her an crazy, playing mind games, making allowance, not letting her know her feel guilty, humiliating her. about or have access to finances.
- Using Male Privilege
- Isolation Treating the woman like a servant, controlling what she does, who making all the big decisions, she sees and talks to, what she acting like the “master of the reads, where she goes, limiting castle,” being the one defining her outside involvement, using gender roles and jealousy to justify actions.
- Using Children
- Minimizing, Denying, and Blaming Making her feel guilty about the abuse, making light of the abuse, using the children to taking her concerns about it relay messages, using visitation seriously, saying the abuse didn’t to harass her, threatening to take happen shifting responsibility for the children away. abusive behavior, saying she caused it.
- Negotiations and Fairness
- Trust and Support Seeking mutually satisfying artner’s support each other’s life resolutions to conflict, being goals, respect right to each others’ opinions, willing to compromise, and feelings, friends, activities, and accepting change.
- Economic Partnership
- Honesty and Accountability Making money decisions together, Accepting responsibility for own making sure both partners benefit actions, admitting being wrong, from financial arrangements communicating openly and honestly.
- Shared responsibility
- Respect Mutually agreeing on a fair Listening non-judgmentally and distribution of work, making valuing other’s opinions. Being family decisions together. emotionally affirming and understanding.
- Responsible Parenting
- Non-threatening Behavior – Sharing parenting jobs, being a Talking and acting so that both positive non-violent role model. feel safe and comfortable expressing self and doing things.
Many of you may be familiar with this chart in another format. A program in Duluth developed it as a pie chart type list of contrasting behaviors. Here we’ve reformatted it to save downloading time and web storage space.
Traditionally most domestic violence programs have focused on victims services. Rightfully so, however, now many are seeing and moving toward the necessity of developing Batterer’s Intervention Programs.
One of the main pitfalls of these programs seems to be the failure of most batterers to acknowledge the need for reeducation. The Family Refuge Center, along with other agencies in the state and across the country are approaching the legal system to encourage them to mandate attendance in an approved Batterer’s Intervention Program as a possible alternative to jail time.
These programs are an attempt to end the cycle of violence that spans generations and crosses economic and cultural boundaries.
Assessing Whether Batterers Will Kill
“ASSESSING WHETHER BATTERERS WILL KILL”
BY B. HART)
FOR MORE INFORMATION CONTACT FAMILY REFUGE CENTER AT 645-6334
Some batterers are life-threatening. While it is true that all batterers are dangerous, some are more likely to kill than others and some are more likely to kill at specific times. Regardless of whether or not there is a protection order in effect, one should constantly evaluate whether an abuser is likely to kill his partner, other family members, and/or police personnel. (We are assuming that the victim is a woman and the abuser is a man. It may be vice versa or it could be that the abuser and victim are of the same sex. Assessment is basically the same despite gender differences. The only additional indicator to be assessed in a lesbian or gay relationship is whether the abuser has been firmly closeted and is now risking exposure as a lesbian or gay person in order to facilitate their severe life-threatening attacks. When a person has been desperately closeted, losing the protection of invisibility in order to abuse potentially suggests great desperation and should be included in this assessment).
Assessment is tricky and never fool-proof. It is important to conduct ongoing assessments, no matter how many times the abuse has occurred or no matter how many times police have been called to the same household. Considering the factors below may or may not reveal actual potential for homicidal assault but the likelihood of a homicide is greater when these factors are present. The greater number of indicators that a batterer demonstrates or the greater the intensity of his indicators, the greater the likelihood of a life-threatening attack. It is important that one use all current/former information known about the batterer. However, reliable information will not be obtained if the victim and perpetrator are interviewed in the same room. Therefore, it is important to interview victims alone. When interviewing, assess for:
- THREATS OF HOMICIDE OR SUICIDE – The batterer who has threatened to kill himself, his partner, the children or her relatives must be considered extremely dangerous.
- FANTASIES OF HOMICIDE OR SUICIDE – The more the batterer has developed a fantasy about who, how, when, and/or where to kill, the more dangerous he may be. The batterer who has previously acted out part of a homicide or suicide fantasy may be invested in killing as a viable “solution” to his problems. As in suicide assessment, the more detailed the plan and the more available the method, the greater the risk.
- WEAPONS – Be aware of a batterer who possess weapons and has used/ threatened to use them during past violent episodes. Access to weapons increases his potential for assault. The use of guns is a strong predictor of homicide. If arson is threatened, fire should also be considered a weapon.
- “OWNERSHIP” OF THE BATTERED PARTNER – The batterer who say “death before divorce!” or “if I can’t have you nobody can” may be stating his fundamental belief that the woman has no right to life separate from him. A batterer who believes he is absolutely entitled to his female partner, her services, her obedience and her loyalty no matter what, is likely to be life-endangering.
- CENTRALITY OF THE PARTNER – A man who idolizes his female partner or who depends heavily on her to organize and sustain his life, or who has isolated himself from all other community, may retaliate against a partner who decides to end the relationship. He rationalizes that her “betrayal” justifies his lethal actions.
- SEPARATION VIOLENCE – When a batterer believes that he is about to lose his partner if he can’t envision life without her or if the separation causes him great despair or rage, he may choose to kill.
- DEPRESSION – When a batterer has been acutely depressed and sees little hope for moving beyond the depression, he may be a candidate for homicide and/or suicide. Research show that many men who are hospitalized for depression have homicidal fantasies directed at family members.
- ACCESS TO THE BATTERED WOMAN AND/OR FAMILY MEMBERS – If the batterer cannot find her, he cannot kill her. If he does not have access to the children, he cannot use them as a means of access to the battered woman. Careful safety planning and police assistance are required for those times when contact is required (e.g. court appearances and custody exchanges).
- REPEATED OUTREACH TO LAW ENFORCEMENT – Partner or spousal homicide almost always occurs in a context of historical violence. Prior calls to the police indicate elevated risk of life-threatening conduct. The more calls, the greater the potential danger.
- ESCALATION OF BATTERER RISK TAKING – A less obvious indicator of increasing danger may be the sharp escalation of personal risk undertaken by a batterer. When a batterer begins to act without regard to the legal or social consequences that previously constrained his violence, chances of lethal assault increase significantly.
- HOSTAGE TAKING – A hostage-taker is at high risk of inflicting homicide. Between 75% and 90% of ALL hostages in the U.S. are related to domestic violence situations.
SIGNS TO LOOK FOR IN A
FOR MORE INFORMATION,
CALL THE FAMILY REFUGE CENTER AT
Many women are interested in ways they can predict whether they are about to become involved with someone who will be physically abusive. Below is a list of behaviors that are seen in people who beat their partners or wives. If a person exhibits 3 or more of the behaviors, there is a strong potential for physical violence. The more signs the person has, the more likely it is that he is a batterer. The last four signs on this list are particularly characteristic of men who batter their partners. Sometimes, a batterer may have only a couple of behaviors that the woman can recognize, but the behaviors are very exaggerated (e.g. extreme jealousy over ridiculous things). Early in the relationship the batterer will try to explain his behavior as signs of love and concern, & the woman may be flattered at first. As time goes on, the behaviors become more severe & serve to control the woman.
- JEALOUSY – At the beginning of the relationship, the abuser will always say that his jealousy is a sign of love. Jealousy has nothing to do with love, it is a sign of insecurity and possessiveness. He will question the woman about who she talks to, accuse her of flirting, or be jealous of time she spends with family, friends, or children. As the jealousy progresses, he may call her frequently during the day, drop by unexpectedly, refuse to let her work for fear she’ll meet someone, or do strange things like check her car mileage or have friends watch her.
- CONTROLLING BEHAVIOR – At first, the batterer will say that this behavior is because he’s concerned for the woman’s safety, her need to use time well, or her need to make good decisions. He will be angry if the woman is “late” coming back from the store or an appointment. He will question her closely about where she went, who she talked to, etc. As time goes on, he may not let the woman make personal decisions about the house, her clothing, or going to church. He may make her ask permission to leave the house or room and he may begin keeping complete control over the household finances.
- QUICK INVOLVEMENT – Many battered women dated or knew their abuser for less than 6 months before they were engaged or living together. He comes on like a whirlwind and says things like “You’re the only person I could ever talk to” or “I’ve never loved anybody like this before”. He needs someone desperately and will pressure the woman to commit to him.
- UNREALISTIC EXPECTATIONS – He is very dependent on the woman for all his needs. He expects her to be the perfect wife, mother, lover, friend. He will say things like “I’m all you need – you’re all I need” or “if you love me you would…”. The woman is expected to take care of everything for him both emotionally and within the home.
- ISOLATION – The man tries to cut the woman off from all resources. If she has men friends she is a “whore”. If she has women friends she is a “lesbian”. If she is close to her family she is “tied to the apron strings”. He accuses people who are of support to her of “causing trouble”. He may want to live in a particularly rural area without a phone. He may not let her use the car, and he may try to keep her from working or going to school.
- BLAMES OTHERS FOR HIS PROBLEMS – If he is chronically unemployed, someone is always doing him wrong or is out to get him. He may make mistakes and then blame the woman for upsetting him and keeping him from concentrating on his job. He will tell the woman that she is at fault for almost anything that goes wrong.
- BLAMES OTHERS FOR HIS FEELINGS – He will tell the woman “you make me mad” “you’re hurting me by not doing what I ask” or “I can’t help being angry”. HE really makes the decisions about what he thinks and feels but will use feelings to manipulate the woman. Harder to catch are his claims that “you make me happy” or “you control how I feel”.
- HYPERSENSITIVITY – This man is easily insulted. He claims his feeling s are “hurt” when he’s really very mad, or he takes the slightest setback as a personal attack. He will “rant and rave” about the injustice of things that have happened to him, things that are really just part of living; like being asked to work over-time, getting a traffic ticket, being told that something he does is annoying, being asked to help with chores, etc.
- CRUELTY TO ANIMALS OR CHILDREN – This is a man who punishes animals brutally or is insensitive to their pain. He may expect children to be capable of doing things far beyond their ability (whips a 2 year-old for wetting a diaper) or he may tease children or younger brothers and sisters until they cry. (60% of men who beat the woman they are with also beat their children). He may not want children to eat at the table or expect them to stay in their room during the evening while he is home.
- “PLAYFUL” USE OF FORCE IN SEX – This man may like to throw the woman down and hold her during sex; he may want to act out fantasies during sex where the woman is helpless. He is letting her know that the idea of “rape” excites him. He may show little concern about whether or not the woman wants to have sex and/or will use anger or sulking to manipulate her into cooperating. He will say she must stay at home and must obey him in all things – even in things that are criminal in nature. The abuser sees women as inferior to men, more stupid, or unable to be a whole person without a relationship.
- DR JEKYLL & MR. HYDE – Many women are confused by their abuser’s “sudden” changes in mood. They report that one minute he’s nice and the next he’s explosive. Women attribute this to a “mental problem” or insist that he is “crazy”. Explosiveness and mood swings are typical of men who beat their partners and these behaviors are related to other characteristics such as hypersensitivity.
- * PAST BATTERING – The man may say he has hit women in the past, but they made him do it. The woman may hear stories from relatives or ex-spouses that the man is abusive. A batterer will beat any woman he is with: situational circumstance do not make a person have an abusive personality.
- * THREATS OF VIOLENCE – This includes any threat of physical force meant to control the woman. “I’ll slap your mouth off” “I’ll kill you”. “I’ll break your neck”. Most men do NOT threaten their mates but a batterer will try to excuse this behavior by saying “everybody says that”.
- * BREAKING/STRIKING OBJECTS – The man will break a woman’s cherished possessions as punishment or in an effort to terrorize her. He may also beat tables with fists or throw objects at/near the woman.
- * ANY FORCE DURING ARGUMENT – The man may hold the woman down, physically restrain her from leaving, push/shove her, or pin her to the wall and say “you’re going to listen to me”.
Are you involved with an abusive partner?
Domestic violence is a pattern of coercive behavior used to maintain power and control in a relationship. Abusive partners repeatedly subject their victims to physical, verbal, emotional and financial tactics in order to maintain control. Answer these questions honestly and score like this:
0 = NEVER 1 = RARELY 2 = SOMETIMES 3 = FREQUENTLY
___ Does he/she keep track of your time?
___ Does he/she discourage you from developing or maintaining friendships?
___ Does he/she accuse you of having affairs?
___ Does he/she criticize you for unimportant things?
___ Does he/she make you feel ashamed?
___ Does he/she try to make you believe that they are smarter than you and therefore,
better able to make decisions?
___ Does he/she use money as a way of controlling you?
___ Does he/she try to make you believe that you cannot exist without him/her?
___ Does he/she try to embarrass you in front of other people?
___ Does he/she say or do things that you make excuses for?
___ Does he/she try to make you feel that you are “crazy”?
___ Do you often feel there is no way out of your situation?
___ Do you “stuff” you feelings in order to “keep the peace”?
___ Do you believe that you could help your abuser change their behavior if only you could
change yourself in some way?
___ Do you feel that not making him/her angry has become a major part of your life?
___ Does he/she get extremely angry without a reason?
___ Does he/she restrain you from leaving after you have been arguing?
___ Does he/she not believe that they have hurt you?
___ Does he/she lose control when drinking alcohol or using drugs?
___ Has he/she threatened you with a weapon?
___ Has he/she been violent toward your children?
___ Does he/she treat you roughly: grab, punch, slap, or shove you?
___ Does he/she threaten you verbally?
___ Has he/she ever hurt you sexually?
___ Has he/she ever forced you to have sexual relations against your will?
___ Do you do what he/she wants for fear of what they might do?
___ Do you stay in the relationship out of fear of what he/she might do if you leave?
___ Does he/she threaten to kill himself/herself if you leave?
___ Does he/she threaten to kill you or family members if you leave?
___ Does he/she destroy your personal things or harm your pets?
Add up your points. Scoring:
1 – 14 relatively normal
15 – 40 moderately abusive
41 – 60 seriously abusive
61 – 90 dangerously abusive
DOMESTIC VIOLENCE HEALTH STATISTICS
SCOPE OF THE PROBLEM
- 8 million women are physically, sexually, or emotionally abused annually in the U.S. (AMA)
- Battering is the #1 cause of injury to women in the U.S. It accounts for more injury to women than rapes, muggings, and car accidents combined. (AMA)
- 50% of all women seen in medical practices in the U.S. will receive at least 1 serious beating from a partner or spouse in her lifetime. (AMA)
- The average victim of DV will be physically abused 3 times per year. (AMA)
- The National Crime Survey reports that DV is associated with: 30,000 ER visits, 40,000 physician visits, 21,000 hospitalizations, and more than 100,000 days of hospitalization time per year (Moss & Taylor)
- The total annual health care costs of DV are estimated at $44,393,700.00 (Moss & Taylor)
- 20-45% of all injuries seen in ERs are the result of DV (Flitcraft)
- 2/3 of all women who are murdered die as a result of DV (Flitcraft)
- Battered women are given 3 times more psychotropic meds, pain pills, and tranquilizers than their non-battered counterparts (Moss & Taylor)
- Of battered women who seek medical treatment, only 1 in 10 is identified as a battered woman by the ER physician/nurse. For primary care clinics, the number stands at 1 in 20 (Sassetti)
- Only 1 in 25 women who are battered seek medical treatment immediately following a violence incident (Sassetti)
- 25-45% of all women who are battered are battered during pregnancy (March of Dimes)
- In 1995, on average, 2.3 victims were murdered per month in WV. The total number of shelter nights provided in WV that year was 18,665 (WVCADV)
- These figures are markedly low & do not provide accurate statistics.
Personalized safety plan for the abused
A print ready page that lists steps and items to prepare in case a speedy escape is required.
Domestic Violence Interventions for Medical Personnel
Create a Climate:
- Establish a safe and secure environment. Ensure confidentiality, informed consent and patient autonomy. Provide privacy; never ask about abuse in front of family or household members.
- Display posters, brochures, and publications on domestic violence in examining rooms as well as in waiting room.
- Develop knowledge of local domestic violence programs.
- “Because abuse and violence have become so common, I routinely ask all my patients about this problem.” Institute routine screening on all patients *JCAHO Standards.
- Interview in private.
- Be alert for subtle signs as well as red flags.
- Inquire in a sensitive, respectful, non-judgmental manner.
- Take complete history – Presenting problem or chief complaint. Review previous and current charts. Patient’s appearance and demeanor. Relevant medical, sexual, social, and medication history.
- Don’t judge patient (or yourself) by patient’s response to you. A victim of abuse will take steps to leave when they have the strength and support to do so.
- Health provider role is to provide medical care, acknowledge and validate the home situation as being abusive, offer options and referrals to local domestic violence program.
Intervene by Building Trust and Providing Support
- Listen actively, non-judgmentally, with respect.
- Assure concern for health and welfare. Assess for potential danger and develop a safety plan.
- If patient is not ready to acknowledge fears, abuse, or ask for help; you could say:
- I am afraid for your safety.
- I am afraid for the safety of your children.
- It will only get worse. Violence increases in seriousness over time without some type of intervention.
- I am here for you when you are ready to leave. We also have a local domestic violence program, which can help you plan to leave safely.
- You deserve better than this. No one deserves to be treated this way.
Document Injury and Symptoms
Records should include:
- Patient’s history and statements.
- Description and location of injuries (use body map).
- Physical examinations (symptoms and clinical findings).
- Diagnostic procedures, including lab and x-ray.
- Photographs of injuries with consent form and time, date and name of photographer.
- Community consultations and resource referrals.
Referral to Local Resources
- Contact your local domestic violence agency for information, brochures, posters and services provided. They often can provide an in-service training for your staff. All people in your offices should know and be able to refer domestic violence victims to local resources in case you are unavailable
- Check out other resources such as National Domestic Violence Hotline 1-800-799-SAFE(7233)
- Family Violence Prevention Fund at www.fvpf.org
Health Privacy Principles for Protecting Victims of Domestic Violence
This information was taken from an article at http://www.fvpf.org
Guiding Principle:All policy, protocol, and practice surrounding the use and disclosure of health information regarding victims of domestic violence should respect patient autonomy and confidentiality and serve to improve the safety and health status of victims of domestic violence.
- De-identified information: Personal identifiers should be removed, to the fullest extent possible, before information is used or disclosed.
- Safeguards: Health care organizations should implement security safeguards to prevent unauthorized access to health information.
- Patient Access: An individual should have the right to access, correct, amend, and supplement her or his own health information.
- Notice: Individuals should receive notice of how health information is used and disclosed.
- Patient Authorization: Identifiable health information should not be disclosed without patient authorization (including minors).
- Provider Discretion: Health care professionals should have broad discretion to withhold information from third parties when disclosure could harm the patient who is the subject of the information.
- Alternative Address: A victim should be permitted to provide alternative contact information for billing and communications.
- Warrants and Court Orders: Health information should not be disclosed to law enforcement personnel without a warrant or court order and only relevant information should be disclosed in civil proceedings.
- Mandatory Reporting: Mandatory reporting and other laws specifically related to domestic violence should be examined and amended as necessary to address privacy.
- Chain of Trust: Privacy protections should follow the data.
- Penalties: Strong and effective remedies for violations of privacy protections should be established.
PRACTICAL IDEAS ABOUT
HOW TO HELP
Someone you suspect
is a victim of
~ A guide for health practitioners ~
FOR MORE INFORMATION, CALL
THE FAMILY REFUGE CENTER AT
(304) 645-6334 OR (866) 645-6334
- Validate and offer support – sometimes that’s all that’s needed
- Know local resources, shelter location, magistrate numbers, etc.
- Know how to safety plan if she is in danger – or get someone who can
- Repeat Sara Buel suggestions:
- “I’m concerned for you and the safety of your children.
- The abuse always gets worse.
- I’m here for you when you’re ready.
- You deserve better than this”.
- Establish THEN FOLLOW a DV protocol. This should contain a mechanism on how to routinize inquiry about abuse and the item(s) should be placed on routine assessment tools.
- Write thorough, objective medical reports about violent incidents in the patient’s own words (e.g. “my husband hit me with a ball bat” rather than “patient alleges abuse”). Medical records stand alone in misdemeanor cases in WV and you won’t need to go to court to defend the medical record.
- With patient’s permission, take pictures of injuries/trauma. (Be sure to include 1 of face, her name, date, and your name)
- Follow-up appointments decrease isolation and give support
During a November, 1995 conference, Dr. Ann Flitcraft, M.D. offered 3 clinical intervention strategies providers can use to assist victims in their practice. These are:
- IDENTIFY/ACKNOWLEDGE – that the patient’s abusive situation at home is a health care problem. It is not something for only the legal community to deal with. It is ridiculous to stabilize a gunshot wound without talking about how it was inflicted. Likewise it is inappropriate to prescribe with out an understanding of how the patient is treated at home.
- PROVIDE MEDICAL CARE IN THE CONTEXT OF THE VIOLENCE – if a woman has a spinal cord injury from being thrown off a roof, she did not have an “accident”. Be supportive and respectful. Don’t minimize. Being able to discuss the abuse is part of the healing process. Ask supportive, non-judgmental questions, and call it what it is.
- ALWAYS CONSIDER SAFETY – Before the patient leaves the office, address the 3 issues of injury, isolation, and fear. With respect to injury, find out if there are weapons in the home and if injuries are more frequent/severe. With respect to isolation, find out how many people (other than the abuser) the woman sees daily. Discuss outside activities, where she goes, who she sees, etc. Finally, discuss fear. The greater the fear, isolation, and injuries, the greater the level of danger.