Domestic Violence DTW

1. Definitions
2. Key Points
   1. Prevalence
   2. Course
   3. Effects
   4. Know Your State Laws
3. Assessment
   1. Before assessing, discuss confidentiality
   2. Who and how often to assess (see table)
   3. Asking about intimate partner violence
   4. How to assess
   5. What to ask
4. Management
   1. Responding to disclosure of intimate partner violence by parent
      1. Support the victim
      2. Provide information on intimate partner violence
      3. What to say to the child who has witnessed intimate partner violence
      4. For adolescents who are victims of violence
      5. Assess and address safety issues (see Safety Plan for Adult Victims Living With Their Abusers and Safety Instructions)
      6. Referrals for adult parents and adolescents
      7. Referrals for children
   2. Responding to child disclosure of intimate partner violence
   3. Reporting requirements for child abuse and intimate partner violence
   4. Documentation
   5. What to do if a patient says "no" or will not discuss abuse
5. Appendix
   1. Who and How Often to Assess
6. Citations

Comments

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• Domestic violence: Implies that two people are living together; not necessarily true; therefore, we will use the term 'intimate partner violence'
  Implies that two people are living together; not necessarily true; therefore, we will use the term 'intimate partner violence'
• Intimate partner violence: a pattern of purposeful coercive behaviors that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation and threats. These behaviors are perpetrated by someone who is, was or wishes to be involved in an intimate or dating relationship with an adult or adolescent victim and are aimed at establishing control of one partner over the other.
  a pattern of purposeful coercive behaviors that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation and threats. These behaviors are perpetrated by someone who is, was or wishes to be involved in an intimate or dating relationship with an adult or adolescent victim and are aimed at establishing control of one partner over the other.
• Parental disclosure of abuse is a call for help: Children who grow up with violence in the home learn early and powerful lessons about the use of violence in interpersonal relationships. They learn that violence is an acceptable way to assert one's views, get one's way or to discharge stress. These children also learn that violence may be an inherent part of loving relationships. Exposure to violence thus provides justification for children to use violence in their own relationships. This may be particularly true for adolescents.
  Children who grow up with violence in the home learn early and powerful lessons about the use of violence in interpersonal relationships. They learn that violence is an acceptable way to assert one's views, get one's way or to discharge stress. These children also learn that violence may be an inherent part of loving relationships. Exposure to violence thus provides justification for children to use violence in their own relationships. This may be particularly true for adolescents.
• Course: Most violence continues for a long time and often gets more frequent and more severe.
  Most violence continues for a long time and often gets more frequent and more severe.
• adverse physical health effects: arthritis, chronic neck or back pain, migraine and other frequent headaches, stammering, sexually transmitted infections, chronic pelvic pain, peptic ulcers, spastic colon, and frequent indigestion, diarrhea or constipation. Additionally, optimal management of other chronic illnesses such as asthma, HIV/AIDS, seizure, diabetes and hypertension may be problematic in women who are being abused. Emerging research shows that women who are abused are less likely to engage in important preventive health care behaviors such as regular mammography. Intimate partner violence is also linked with significant short- and long-term mental health consequences for victims.
  arthritis, chronic neck or back pain, migraine and other frequent headaches, stammering, sexually transmitted infections, chronic pelvic pain, peptic ulcers, spastic colon, and frequent indigestion, diarrhea or constipation. Additionally, optimal management of other chronic illnesses such as asthma, HIV/AIDS, seizure, diabetes and hypertension may be problematic in women who are being abused. Emerging research shows that women who are abused are less likely to engage in important preventive health care behaviors such as regular mammography. Intimate partner violence is also linked with significant short- and long-term mental health consequences for victims.
• On Children: intervening on behalf of battered women is an active form of child abuse prevention
  intervening on behalf of battered women is an active form of child abuse prevention
• General effect: Witnessing violence affects the way children view the world and their place in it. They come to see the world as a dangerous and unpredictable place. This fear may limit their exploration of their environment, which is the key to learning in childhood.
  Witnessing violence affects the way children view the world and their place in it. They come to see the world as a dangerous and unpredictable place. This fear may limit their exploration of their environment, which is the key to learning in childhood.
• Victims of direct abuse: In 30 to 60 percent of families affected by intimate partner violence, children are also directly abused. Young children and adolescents are more vulnerable to the abuse. Very young children cannot get out of harm's way, and adolescents more frequently intervene to stop the violence, thereby putting themselves at greater risk for injury.
  In 30 to 60 percent of families affected by intimate partner violence, children are also directly abused. Young children and adolescents are more vulnerable to the abuse. Very young children cannot get out of harm's way, and adolescents more frequently intervene to stop the violence, thereby putting themselves at greater risk for injury.
• Post Traumatic Stress Disorder symptoms: Children who are exposed to intimate partner violence, particularly chronic episodes of violence, often show symptoms associated with posttraumatic stress disorder. One study found that exposure to intimate partner violence (without being directly victimized) was sufficiently traumatic to precipitate moderate to severe symptoms of posttraumatic stress in 85 percent of the children.
  Children who are exposed to intimate partner violence, particularly chronic episodes of violence, often show symptoms associated with posttraumatic stress disorder. One study found that exposure to intimate partner violence (without being directly victimized) was sufficiently traumatic to precipitate moderate to severe symptoms of posttraumatic stress in 85 percent of the children.
• Behavioral and physical problems: Children who are exposed to intimate partner violence are more likely to exhibit behavioral and physical health problems including chronic somatic complaints, depression, anxiety and violence towards peers. They are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teenage prostitution and commit sexual assault crimes. Children who are exposed to intimate partner violence have increased difficulties with learning and school functioning. Symptoms of trauma including sleep difficulties, hyper-vigilance, poor concentration and distractibility which interfere with a child's ability to focus and to complete academic tasks in a school setting.
  Children who are exposed to intimate partner violence are more likely to exhibit behavioral and physical health problems including chronic somatic complaints, depression, anxiety and violence towards peers. They are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teenage prostitution and commit sexual assault crimes. Children who are exposed to intimate partner violence have increased difficulties with learning and school functioning. Symptoms of trauma including sleep difficulties, hyper-vigilance, poor concentration and distractibility which interfere with a child's ability to focus and to complete academic tasks in a school setting.
• Effect on parenting: The emotional consequences of being injured, harassed or terrified may be significant for the parent who is victimized. That parent may be less attuned to children's needs or less emotionally available to the children. However this does not mean that victims of intimate partner violence are inherently abusive or neglectful of their children. Parents who batter are generally less involved with child rearing, more likely to use physical punishment and less able to distinguish or recognize the child's needs as separate from the parent's needs.
  The emotional consequences of being injured, harassed or terrified may be significant for the parent who is victimized. That parent may be less attuned to children's needs or less emotionally available to the children. However this does not mean that victims of intimate partner violence are inherently abusive or neglectful of their children. Parents who batter are generally less involved with child rearing, more likely to use physical punishment and less able to distinguish or recognize the child's needs as separate from the parent's needs.
• Effect on own future relationships : Children who grow up with violence in the home learn early and powerful lessons about the use of violence in interpersonal relationships. They learn that violence is an acceptable way to assert one's views, get one's way or to discharge stress. These children also learn that violence may be an inherent part of loving relationships. Exposure to violence thus provides justification for children to use violence in their own relationships. This may be particularly true for adolescents.
  Children who grow up with violence in the home learn early and powerful lessons about the use of violence in interpersonal relationships. They learn that violence is an acceptable way to assert one's views, get one's way or to discharge stress. These children also learn that violence may be an inherent part of loving relationships. Exposure to violence thus provides justification for children to use violence in their own relationships. This may be particularly true for adolescents.
• Know your state laws about reporting to CPS.: Often, when an individual discloses that he or she has been abused or injured by a spouse, it is a clear request for help. Yet there are many reasons why an individual stays in such a relationship. A clinician should not take action without fully understanding whether the parent in need is ready for help. CPS = Child Protective Services
  Often, when an individual discloses that he or she has been abused or injured by a spouse, it is a clear request for help. Yet there are many reasons why an individual stays in such a relationship. A clinician should not take action without fully understanding whether the parent in need is ready for help. CPS = Child Protective Services
• Know your local resources: The clinician should be aware of resources that are available in the community to shelter individuals in situations involving domestic violence. While a clinician cannot insist that an individual seek refuge in such a shelter, the more the clinician knows about the facilities that are available (whether the facility accepts children, how much security is available, what languages are spoken, etc.), the more he or she will be able to act when the individual is ready for help.
  The clinician should be aware of resources that are available in the community to shelter individuals in situations involving domestic violence. While a clinician cannot insist that an individual seek refuge in such a shelter, the more the clinician knows about the facilities that are available (whether the facility accepts children, how much security is available, what languages are spoken, etc.), the more he or she will be able to act when the individual is ready for help.
• Before assessing, discuss confidentiality: Before asking about intimate partner violence, you may want to disclose any limits of confidentiality. Since many adolescents who are victimized by an intimate partner do not want their family to know about an intimate relationship, it is important that you understand and explain the limits of confidentiality of both their medical record and reporting before screening.
  Before asking about intimate partner violence, you may want to disclose any limits of confidentiality. Since many adolescents who are victimized by an intimate partner do not want their family to know about an intimate relationship, it is important that you understand and explain the limits of confidentiality of both their medical record and reporting before screening.
• What to ask: Intimate partner violence questions can be framed within discussion of other safety issues such as car and bicycle helmet safety, and assessing for guns at home or community violence.
  Intimate partner violence questions can be framed within discussion of other safety issues such as car and bicycle helmet safety, and assessing for guns at home or community violence.
• Assess and address safety issues: Before your adolescent patient or a parent leaves, talk with her/him about immediate and future safety. These questions can also be asked over time and during subsequent visits.
  Before your adolescent patient or a parent leaves, talk with her/him about immediate and future safety. These questions can also be asked over time and during subsequent visits.
• Documentation: Putting information about intimate partner violence in child's chart may not be advisable if batterer has access to child's chart
  Putting information about intimate partner violence in child's chart may not be advisable if batterer has access to child's chart