WHAT MEDICAL PROFESSIONALS
NEED TO KNOW
2ND Edition
Florida Dental CE Broker Provider # 50-1997 – CE Course Tracking # 20-160830
THIS IS A 2 HOUR COURSE
The Institute for Advanced Therapeutics, Inc.
P.O. Box 848152
Pembroke Pines, Florida 33084
1-954-441-9553
DOMESTIC VIOLENCE
WHAT MEDICAL PROFESSIONALS
NEED TO KNOW
2nd Edition
Consultants:
Mark D. Blum, D.D.S.
Research and Development:
Charles Edwin Cook, L.M. T., C.R. T.
Editor:
Mark D. Blum, D.D.S.
By:
Renee Demmery, C.R.T.
©2007 Renee Demmery
All Rights Reserved
DOMESTIC VIOLENCE
WHAT MEDICAL PROFESSIONALS
NEED TO KNOW
2nd Edition
Published By:
The Institute for Advanced Therapeutics, Inc.
P.O. Box 848152
Pembroke Pines, Florida 33084
1-954-441-9553 tel
1-954-432-1824 fax
This course was developed to help expand the knowledge and skills of medical professionals with respect to the subject of domestic violence. The information in this course has been derived from various professional sources.
It is the responsibility of the medical professional to determine which principles and theories contained herein are appropriate with respect to his/her personal limitations and scope of practice.
The information in this course has been carefully researched and is generally accepted as factual at the time of publication. The Institute for Advanced Therapeutics, Inc. disclaims responsibility for any contradictory data prior to the publication of the next revision of this course.
NOTE: In this book and test, the use of the words patient, victim, and survivor can be interchanged. In this book and test, the use of the words health care professional and health care worker can be interchanged.
Disclaimer: The intervention suggestions outlined in this textbook are not meant as a prescription but are intended for information purposes only.
The images used herein were obtained from IMSI's MasterClips® and MasterPhotosä Premium Image Collection, 1895 Francisco Blvd. East, San Rafael, CA 94901-5506, USA.
TABLE OF CONTENTS
COURSE DIRECTIONS
MAILING INSTRUCTIONS
COURSE OBJECTIVES
INTRODUCTION TO DOMESTIC VIOLENCE
TYPES OF INTIMATE PARTNER VIOLENCE
RISK FACTORS FOR VICTIMIZATION
RISK FACTORS FOR PERPETRATION
SIGNS OF AN ABUSIVE RELATIONSHIP
DOMESTIC VIOLENCE IN SPECIAL CIRCUMSTANCES
HEALTH CONSEQUENCES OF DOMESTIC VIOLENCE
SCREENING FOR DOMESTIC VIOLENCE
FLORIDA REPORTING REQUIREMENTS
FOR DOMESTIC VIOLENCE
INTERVENTION GUIDELINES
RESOURCES
PREVENTION STRATEGIES
DEVISING A SAFETY PLAN FOR SURVIVORS
INSTRUCTIONS FOR COMPLETING THE TEST
DOMESTIC VIOLENCE 2nd EDITION TEST
TEST ANSWER CARD – COURSE EVALUATION
REFERENCE LIST
COURSE DIRECTIONS
HOW TO BEST PROCEED WITH THIS COURSE
Each chapter should be approached systematically in a careful and objective manner. It is important to master each chapter before going on to the next. Relax, take your time, and go at your own pace. As 2 credits of continuing education is rewarded after successfully completing this course, the reading of this manual and completion of the test questions should not take less than 2 hours. Only after you have successfully mastered all the material in the course should you proceed to the post-test questions.
COMPLETING THE POST-TEST
Before beginning, please clearly write your name, address, zip code, and license number on your post-test answer card. Read each question carefully before answering. Please use a ballpoint pen to fill-in your answers on the answer card by completely shading your choice. Keep in mind that each question has only one correct answer. The post-test consists of 20 questions. For a passing grade, you must correctly answer 16 questions. We encourage your input and would welcome any suggestions to improve our course or test questions. Please feel free to note your suggestions or comments on the course evaluation found at the bottom of the test answer card.
INFORMATION FOR CERTIFICATION
In order to receive your 2 hours of continuing education credit, you must be a registered purchaser of this course. Only one person per purchase of this course is eligible to receive credit. Please notify us of any address or name changes as we keep permanent records for certification and licensure.
MAILING INSTRUCTIONS
Please send FAX OR MAIL your completed test answer card and course evaluation to:
The Institute for Advanced Therapeutics, Inc.
P.O. Box 848152
Pembroke Pines, Florida 33084
If you have any questions regarding this course, please contact our Customer Service Department at 1-954-441-9553 or fax us at 1-954-432-1824.
COURSE OBJECTIVES
Upon completion of this course, you will be able to:
1. Recognize the signs of an abusive relationship.
2. Discuss ways to screen patients for domestic violence.
3. Describe risk factors for victimization and perpetration.
4. Understand how to appropriately document cases of domestic violence in the medical record.
5. Identify state and national domestic violence resources.
6. Describe Florida domestic violence reporting requirements.
INTRODUCTION TO DOMESTIC VIOLENCE
Domestic violence, also known as intimate partner violence, occurs between two people who are currently involved in an intimate relationship with each other or who have once been involved in an intimate relationship with each other – current or former spouse, current or former boyfriend/girlfriend, or current or former date. The Centers for Disease Control and Prevention (CDC) describes intimate partner violence as “actual or threatened physical or sexual violence, or psychological and emotional abuse, directed toward a spouse, ex-spouse, current or former boyfriend or girlfriend, or current or former dating partner.”
The U.S. Department of Justice, Bureau of Justice Statistics reports that 92% of the victims of domestic violence are women abused by men. Regardless of the relationship between the two individuals involved, domestic violence is a crime.
Nearly 5.3 million incidents of intimate partner violence occur each year among U.S. women ages 18 and older, and 3.2 million occur among men. Most assaults are relatively minor and consist of pushing, grabbing, shoving, slapping, and hitting (Tjaden and Thoennes 2000a).
In the United States every year, about 1.5 million women and more than 800,000 men are raped or physically assaulted by an intimate partner. This translates into about 47 IPV assaults per 1,000 women and 32 assaults per 1,000 men (Tjaden and Thoennes 2000a).
Intimate partner violence results in nearly 2 million injuries and 1,300 deaths nationwide every year. (CDC 2003).
As health care professionals, there is a unique opportunity to be able to recognize signs of domestic abuse and intervene before more serious injuries occur.
TYPES OF INTIMATE PARTNER VIOLENCE
There are four main types of intimate partner violence (Saltzman et al. 2002):
Physical violence is the intentional use of physical force with the potential for causing death, disability, injury, or harm. Physical violence includes, but is not limited to, scratching; pushing; shoving; throwing; grabbing; biting; choking; shaking; slapping; punching; burning; use of a weapon; and use of restraints or one’s body, size, or strength against another person.
Sexual violence is divided into three categories:
1) use of physical force to compel a person to engage in a sexual act against his or her will, whether or not the act is completed;
2) attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, to decline participation, or to communicate unwillingness to engage in the sexual act, e.g., because of illness, disability, or the influence of alcohol or other drugs, or because of intimidation or pressure; and
3) abusive sexual contact.
Threats of physical or sexual violence use words, gestures, or weapons to communicate the intent to cause death, disability, injury, or physical harm.
Psychological/emotional violence involves trauma to the victim caused by acts, threats of acts, or coercive tactics. Psychological/emotional abuse can include, but is not limited to, humiliating the victim, controlling what the victim can and cannot do, withholding information from the victim, deliberately doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family, and denying the victim access to money or other basic resources. It is considered psychological/emotional violence when there has been prior physical or sexual violence or prior threat of physical or sexual violence.
In addition, stalking is often included among the types of IPV. Stalking generally refers to repeated behavior that causes victims to feel a high level of fear (Tjaden and Thoennes 2000).
RISK FACTORS FOR VICTIMIZATION
Individual Factors
· Prior history of IPV
· Being female
· Young age
· Heavy alcohol and drug use
· High-risk sexual behavior
· Witnessing or experiencing violence as a child
· Being less educated
· Unemployment
· For men, having a different ethnicity from their partner’s
· For women, having a greater education level than their partner’s
· For women, being American Indian/Alaska Native or African American
· For women, having a verbally abusive, jealous, or possessive partner
Relationship Factors
· Couples with income, educational, or job status disparities
· Dominance and control of the relationship by the male
Community Factors
· Poverty and associated factors (e.g., overcrowding)
· Low social capital, lack of institutions, relationships, and norms that shape the quality and quantity of a community’s social interactions
· Weak community sanctions against IPV (e.g., police unwilling to intervene)
Societal Factors
· Traditional gender norms (e.g., women should stay at home and not enter workforce, should be submissive)
RISK FACTORS FOR PERPETRATION
Individual Factors
· Low self-esteem
· Low income
· Low academic achievement
· Involvement in aggressive or delinquent behavior as a youth
· Heavy alcohol and drug use
· Depression
· Anger and hostility
· Impulsive tendencies
· Personality disorders
· Prior history of being physically abusive
· Preference for impersonal sex
· Having few friends and being isolated from other people
· Unemployment
· Economic stress
· Emotional dependence and insecurity
· Belief in strict gender roles (e.g., male dominance and aggression in relationships)
· Desire for power and control in relationships
· Being a victim of physical or psychological abuse (consistently one of the strongest predictors of perpetration)
Relationship Factors
· Marital conflict, fights, tension, and other struggles
· Marital instability, divorces and separations
· Dominance and control of the relationship by the male
· Economic stress
· Unhealthy family relationships and interactions
Community Factors
· Poverty and associated factors (e.g., overcrowding)
· Low social capital, lack of institutions, relationships, and norms that shape the quality and quantity of a community’s social interactions
· Weak community sanctions against IPV (e.g., unwillingness of neighbors to intervene in situations where they witness violence)
Societal Factors
· Traditional gender norms (e.g., women should stay at home and not enter workforce, should be submissive)
SIGNS OF AN ABUSIVE RELATIONSHIP
Most people recognize battering as a clear sign of an abusive relationship but there are other signs that may not be as obvious. If the partner you love or care about does any of the following things to you, you may be a victim of domestic abuse.
þ Blames you for causing the angry or violent behavior.
þ Repeatedly accuses you of being unfaithful.
þ Refuses to allow you to drive anywhere alone.
þ Prevents or makes it difficult for you to see friends or family.
þ Refuses to allow you to work outside the home or attend school.
þ Gets enraged when under the influence of alcohol or drugs.
þ Pushes, grabs, slaps, kicks, or bites you.
þ Threatens to hurt or punish you, your children or your pets.
þ Threatens suicide to punish you.
þ Uses or threatens to use a gun, knife, or other dangerous weapon against you.
þ Forces you into sexual activity against your will.
þ Constantly belittles you.
þ Wants to know where you are and what you are doing all the time and constantly checks up on you.
þ Humiliates you in front of friends, family, co-workers, or others.
þ Controls all the finances and any money you spend.
þ Criticizes you and calls you names in an effort to make you feel bad about yourself.
þ Uses the children as pawns by threatening to take them away from you should you decide to leave the relationship.
þ Damages or destroys your personal property or items of sentimental value to you.
þ Attempts to sabotage your job by calling you constantly at work, showing up frequently during the day, takes up issues with your boss on your behalf, or causing you to frequently miss work.
þ Insists on making all the decisions in your life.
þ Threatens you if certain chores are not performed on time.
þ Checks the odometer on your car to see how many miles were driven by you each day.
þ Intercepts your mail, phone messages, or email messages.
þ Restrains you to prevent you from escaping during an argument.
þ Ignores your needs.
þ Breaks promises.
þ Always claims to be right.
þ Disrespects you.
þ Lies and cheats on you.
þ Uses pressure tactics to manipulate you.
þ Frequently uses foul language, yells or swears at you.
þ Chokes, slaps, or punches you.
þ Purposely does things to frighten or intimidate you.
þ Deprives you of things that make you happy.
þ Does not take your concerns seriously.
þ Stalks you.
þ Refuses to leave when asked.
þ Refuses to take “no” for an answer.
þ Makes “rules” you must obey or makes you suffer the consequences.
þ Threatens you with a lawsuit following a separation.
þ Discourages or prevents you from seeking medical attention for injuries sustained during a domestic violence episode.
þ Insists on accompanying you to appointments in an effort to control the information you may share.
þ Refuses to leave your side during medical appointments or hospital emergency room visits.
þ Insists on speaking for you on your behalf.
þ Exhibits extremely jealous behavior.
þ Makes you feel afraid to voice your opinions.
þ Threatens physical violence or retaliation should you decide to end the relationship.
þ Insists that you ask permission to do things.
DOMESTIC VIOLENCE IN SPECIAL CIRCUMSTANCES