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Innovative Strategies for Dealing with Interpersonal Violence . Phyllis W. Sharps, PhD, RN, FAAN Professor and Associate Dean for Community and Global Programs . Session Objectives . 1. Discuss the importance of universal screening in maternal and child health care settings.

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Innovative strategies for dealing with interpersonal violence

Innovative Strategies for Dealing with Interpersonal Violence

Phyllis W. Sharps, PhD, RN, FAAN

Professor and

Associate Dean for Community and Global Programs


Session objectives
Session Objectives Violence

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.


Violence against women
VIOLENCE AGAINST WOMEN Violence

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


Alarming statistics
ALARMING STATISTICS Violence

  • 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


Alarming statistics1
ALARMING STATISTICS Violence

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


Alarming statistics2
ALARMING STATISTICS Violence

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)



Cost of violence against women
Cost Of Violence Against Women prevalence) Health Outcomes -2011

Cost of non-fatal injuries

  • 1995 = $5.8 M

  • 2012 = > $5.8 B

    Costsare

  • Direct medical/mental health care

  • Lost productivity from paid work & household duties – 13.6 M days of lost productivity


It s important

UNIVERSAL SCREENING prevalence) Health Outcomes -2011

It’s Important


Universal screening
UNIVERSAL SCREENING prevalence) Health Outcomes -2011

  • 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)


Universal screening1
UNIVERSAL SCREENING prevalence) Health Outcomes -2011

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)


Challenges for screening and intervening

BARRIERS prevalence) Health Outcomes -2011

Challengesfor Screening and Intervening


Provider concerns
PROVIDER CONCERNS prevalence) Health Outcomes -2011

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


Women s concerns
WOMEN’S CONCERNS prevalence) Health Outcomes -2011

Embarrassment – to reveal

Victimization – if abuser finds out

What happens to my disclosure – who else knows

Judgmental attitudes – of professionals and other helping professionals


Screening and intervening

STRATEGIES prevalence) Health Outcomes -2011

Screening and Intervening


Violence against women1
Violence Against Women prevalence) Health Outcomes -2011

  • Important Strategies

    • Universal Screening

    • Danger Assessment

    • Safety Planning

    • Referrals (shelters, legal)


Asking questions
Asking Questions prevalence) Health Outcomes -2011

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


Assessment tools
Assessment Tools prevalence) Health Outcomes -2011

Abuse Assessment Screen (AAS)

RADAR

ASSERT


Abuse Assessment Screen prevalence) Health Outcomes -2011

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.


Assessment tools1
Assessment Tools prevalence) Health Outcomes -2011

R:Remember to ask

A:Ask directly

D:Document findings

A:Assess for safety

R:Review options,

refer

(F:) Follow-up

A:Ask

S:Sympathize

S:Safety

E: Educate

R:Refer

T:Treat


Danger assessment campbell 86 2001
Danger Assessment prevalence) Health Outcomes -2011(Campbell ’86, 2001)

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


Provider roles abuse during pregnancy
PROVIDER ROLES: prevalence) Health Outcomes -2011ABUSE DURING PREGNANCY

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 partum


One Love App – Danger Assessment prevalence) Health Outcomes -2011APP for women aged 16-26 www.joinonelove.orgor www.dangerassessment.org

Campbell et al JIPV 2009


prevalence) Health Outcomes -2011Coaching 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


Violence against women2
Violence Against Women prevalence) Health Outcomes -2011

  • Important Strategies

    • Coordinate Community Response

    • Integrated systems

    • Missed Opportunities

  • Empower Women

    • Listen to her story

    • Increase her awareness


Community team process
Community Team Process prevalence) Health Outcomes -2011

Patient Survivors DV Advocates

Legislative Military Physicians

Prevention

Intervention

Treatment

Society Education Social

Services

Governance Health Religious Nurse

Professionals


National domestic violence hotline 1 800 799 safe 7233
NATIONAL DOMESTIC VIOLENCE HOTLINE prevalence) Health Outcomes -20111-800-799-SAFE (7233)


Thank you
THANK YOU prevalence) Health Outcomes -2011

Phyllis W. Sharps, PhD, RN, FAAN

[email protected]

410-614-5312


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