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.
Phyllis W. Sharps, PhD, RN, FAAN
Associate 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.
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
Women are much more likely to be victimized
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 non-fatal injuries
UNIVERSAL SCREENING prevalence) Health Outcomes -2011It’s Important
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)
BARRIERS prevalence) Health Outcomes -2011Challengesfor Screening and Intervening
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
Embarrassment – to reveal
Victimization – if abuser finds out
What happens to my disclosure – who else knows
Judgmental attitudes – of professionals and other helping professionals
STRATEGIES prevalence) Health Outcomes -2011Screening and Intervening
Frame as routine part of practice
Ask direct questions
Ask at very visit
Listen and be sensitive to her story
Avoid minimizing her experience
Abuse Assessment Screen (AAS)
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.
R:Remember to ask
A:Assess for safety
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
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
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
Patient Survivors DV Advocates
Legislative Military Physicians
Society Education Social
Governance Health Religious Nurse