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Family Violence: Intimate Partner Violence (IPV)

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Family Violence: Intimate Partner Violence (IPV) Ashley Owen, Ph.D. Emory University Department of Family and Preventive Medicine SAFETY (review with patient) Know ... – PowerPoint PPT presentation

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Title: Family Violence: Intimate Partner Violence (IPV)


1
Family ViolenceIntimate Partner Violence (IPV)
  • Ashley Owen, Ph.D.
  • Emory University
  • Department of Family and Preventive Medicine

2
Understanding Intimate Partner Violence
3
Understanding Intimate
Partner Violence
Learning Objectives 1.) Place knowledge
about the definition, epidemiology, and
demography of intimate partner violence into a
clinical context. 2.) Develop competence at
routine inquiry about intimate partner violence
using the ASSERT model. 3.) Formulate an action
plan with immediate support for an abused woman
returning to an unsafe environment. 4.)
Facilitate an abused woman's consideration of and
access to local community services and agencies.
4
Key Elements of IPV
  • Usually a pattern of assaultive and coercive
    behavior, not an isolated event includes
    physical, sexual, and psychological attacks, as
    well as economic coercion
  • Perpetrator and victim are
  • known to each other and
  • have shared an
  • intimate relationship.

5
Key Elements of IPV (cont.)
  • A combination of physical attacks and controlling
    tactics used by perpetrators that result in fear,
    as well as physical and psychological harm, to
    their partners and children.
  • A pattern of purposeful behavior, directed at
    achieving compliance from or control over their
    partner.

6
Prevalence of Intimate Partner Violence
  • 22 of women report lifetime prevalence
  • Gay and lesbian couples are at same, and possibly
    grater risk than heterosexuals for partner
    violence (30-40 of lesbians)
  • More prevalent among women than diabetes, breast
    cancer, and cervical cancer
  • 30 of murdered women are killed by their
    intimate male partners
  • Findings of 45 of wives of alcoholic men have
    been beaten (alcohol drug most commonly
    associated with IPV)

7
Family Dynamics of IPV and Alcohol Abuse
  • both substances and violence are used to resolve
    conflict and cope with stress discharges
    tension, ends the argument, or asserts control.
  • secrecy is
  • maintained about
  • both violence and substance abuse (shame, fear
    of unwanted intervention, and the feared career
    or social consequences of disclosure).

8
Family Dynamics of IPV and Alcohol Abuse
  • Particularly due to the increased risk of harm in
    a family that experiences both substance abuse
    and family violence, after treating injuries
  • the provider must
  • FIRST focus on
  • immediate safety planning for the victim of
    violence and other family members.

9
Patient Symptoms often associated with IPV
  • Pain in any place in the body
  • Vaginal discharge
  • Constipation
  • Diarrhea
  • Shortness of breath
  • Choking
  • Difficulty sleeping
  • Fatigue
  • Nightmares
  • Depression and/or anxiety
  • Hx of substance abuse
  • Suicidal Ideation

10
Progression of Violence
  • Phases build-up, explosion, honeymoon

11
What keeps women in the relationship?
  • fear of partners actions (Ill never be safe, I
    might as well live with him)
  • effects of IPV (Cant face making decisions)
  • roles the culture forces on women (guilt,
    economic)
  • personal history (My father beat my mom it just
    goes along with being in a relationship)

12
What keeps women in the relationship?
  • isolation and lack of resources
  • The most harmful tactic an abuser can use is
    isolating the victim from social contacts.
  • The world the victim lives in becomes a reality
    from which it is difficult to escape. (He
    wouldnt let me see friends or family for so
    long, now I dont have anyone to stay with
    anymore)
  • love and hope (I dont want to give up the good
    times I keep hoping hell change)

13
  • How to think about whats going on with your IPV
    patients
  • and how to help them.

14
STAGES OF CHANGE MODEL
15
STAGES OF CHANGE MODEL
  • Changing behavior is a dynamic and cyclical
    process and one progresses through stages in
    trying to modify their behavior
  • Stages of change readiness to change
  • Processes of change techniques or strategies to
    bring about change

16
STAGES OF CHANGE MODEL
  • Assist as your patient moves along the stages of
    change process
  • (transtheoretical model of behavior change)
  • precontemplation
  • contemplation
  • preparation
  • action
  • maintenance

17
STAGES OF CHANGE MODEL
  • Precontemplation
  • typically referred by others
  • do not intend to change
  • relatively unaware of situation
  • defensive
  • feel helpless, and resourceless
  • often accept batterers definition of the
    situation-that violence is her fault
  • counseling thought-oriented

18
STAGES OF CHANGE MODEL
  • Contemplation
  • intend to change but only thinking about it and
    not committed to changing
  • may use this stage to build social and emotional
    support and explore options for financial
    independence
  • stay in this stage for as long as weigh pros and
    cons of leaving the batterer
  • counseling thought-oriented

19
STAGES OF CHANGE MODEL
  • Preparation
  • actively plan to change and are ready for action
  • develop a safety plan
  • discuss with a friend of family member who may
    provide a safe house
  • call an abuse hotline
  • set aside emergency money
  • contact an attorney or law enforcement
  • leave the abuser briefly
  • counseling thought and action-oriented

20
STAGES OF CHANGE MODEL
  • Action
  • overtly make changes
  • implement a safety plan
  • leave abuser
  • demand and receive a reduction in, or an end to,
    the violence

21
STAGES OF CHANGE MODEL
  • Action (cont.)
  • tell others about the IPV and get support
  • obtain community support and resources
  • highest risk of relapse" (recycling) during this
    phase
  • counseling thought and action-oriented

22
STAGES OF CHANGE MODEL
  • Maintenance
  • solidify change and resist temptations to relapse
  • continue to work to maintain a violence-free life
  • counseling thought and action-oriented

23
STAGES OF CHANGE MODEL
  • Once the woman is safe and has progressed to the
    action or maintenance phase,
  • she may choose to engage in interventions for
    her trauma (ex. PTSD).
  • Its not that some people have willpower and
    some dont. Its that some people are ready to
    change and others are not.
  • - James Gordan

24
IPV ASSESSMENT Why is it so
important?
  • Part of any complete interview
  • (contribution to psychiatric/physical concerns)
  • Potential harm of not asking
  • (message to patient, help patient understand
    relations among abuse, health problems, and risk
    bx, unassessed risk)
  • Therapeutic value of compassionate inquiry
  • Inquiry and support really do bring value to
    patients lives.

25
IPV ASSESSMENT Why is it so important?
  • "Since I can't rescue victims, I realize all I
    need to do is be empathetic and supportive, and
    this simple intervention can really help empower
    someone"

26
IPV ASSESSMENT Barriers for providers
  • Lack of IPV education
  • Lack of time
  • Lack of effective interventions
  • Powerlessness
  • Fear of offending the patient
  • Privacy concerns
  • Personal history of abuse

27
IPV ASSESSMENT Barriers for patients
  • Not asked by the clinician
  • Concerns about confidentiality
  • Perception that clinicians are not interested
  • Perception that clinicians have no time
  • Fear of involving the police
  • Embarrassment
  • Fear of retaliation

28
IPV ASSESSMENT HOW TO
  • Ask
  • Sympathize
  • Safety
  • Educate
  • Record
  • Treat (refer)
  • It really is that simple!

29
ASK (sample introduction questions )
  • How would you describe
  • your relationship?
  • How do you and your
  • partner work out problems?
  • I ask many of my patients about
  • their family life as it affects their health
    and safety. May I ask you a few questions?
  • Sometimes when I see an injury like yours, it is
    because somebody got hit. How did you get this
    injury/bruise?

30
ASK (sample introduction questions)
  • What happens when there is a disagreement with
    your partner or others in your home?
  • Have you ever been hurt or threatened by your
    partner?
  • Do you ever feel afraid of (controlled or
    isolated by) your partner?

31
ASK (sample follow-up questions)
  • Has the violence gotten worse or scarier? Is it
    more frequent?
  • Has your partner ever threatened to kill you,
    him/herself or your children?

32
SYMPATHIZE (sample statements)
  • You dont deserve this abuse and it is not your
    fault.
  • Im afraid for your safety and that of your
    children.
  • You are not alone and help is available.
  • I will be here to help you.
  • I am here to listen.
  • I want to help you with this.

33
SAFETY (review with patient)
  • - Do you have an escape route?
  • Doors, stairs, first floor windows, basement
    exits
  • - Do you have a safe place to go to?
  • Home of relative/friend with unconditional
  • support, motel, shelter
  • - Do you have a survival kit?
  • (hide safely or leave with trusted person)
  • Money, extra house and car keys and documents, ID
    documents (passports, birth certificates),
    insurance papers, checkbook and credit cards,
    legal documents (marriage/ separation agreements,
    protection orders, papers of joint ownerships),
    change of clothes, valuable jewelry

34
SAFETY (review with patient)
  • Know Domestic Violence hotline phones and
    research shelter info.
  • Try to start individual savings account
  • (and have statements sent to
  • trusted person).

35
EDUCATE (sample statements)
  • - Violence tends to continue and often becomes
    more frequent and severe. (cycle of
    violence discussion)
  • - Domestic violence is common and happens in all
    kinds of relationships.
  • - Abuse can impact your health in many ways.

36
REPORT
  • Document patients statements within chief
    complaint, history of present illness or social
    history (based on what is most pertinent).
  • Avoid judgmental documentation
  • Use patient declines services at this time and
    patient states (or shares) that instead of
    patient refuses help or patient alleges
  • Offer to report with the patient or provide
    documentation to help him or her report.

37
TREAT
  • Encourage patient to follow up
  • with you (open-door policy).
  • 2) Provide referrals
  • Hotline number
  • Legal referral
  • Shelter number
  • In-house referral

38
IPV Assessment Things to Remember
  • Offer nonjudgmental acceptance and validation of
    the battered woman and her experience
  • Provide immediate support and form a working
    alliance
  • Assume self-determination
  • View coping strategies as strengths, not
    pathology

39
IPV Assessment Things to Remember
  • Not asking may negatively impact the physician
    patient relationship.
  • Statements expressing sympathy, concern, and
    legitimacy enhance patient satisfaction with
    care.
  • Most (74) women want their physicians to ask.

40
IPV Assessment Things to Remember
  • "By backing off from a rescuing role and instead
    respectfully appreciating someone's strengths...,
    my relationship with my patients becomes more
    important in their lives.

41
CONCLUSION/QUESTIONS?
  • Remember
  • WE CAN MAKE A DIFFERENCE!!!
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