1 in 4 women will experience violence in their intimate relationships, (1 in 3 pregnant women). RI has a comprehensive response system in place, but violence against women continues. There are significant new steps women’s health professionals can institute now to de-stigmatize abuse, bring it out of hiding and give patients the tools to choose safety before lethality sets in.
Intimate Partner Violence (IPV) is defined as a pattern of coercive behaviors by someone involved in an intimate relationship with a victim. It is an on-going interplay of excessive power, control and victimization that ripples through family generations, work environments, social relationships, communities and governments.
The place women ought to feel the most safe, i.e., home, is not. Children who witness abuse face developmental delays and poor school performance (whether they have been abused or not). Because of denial and the fear of asking for help, or fear of harm to her children and/or pets, or fear that she’ll lose her children, it often takes six police interventions before a woman will seek safety. And because there are many layers of barriers to leaving a relationship (economic, cultural, habit, isolation, shame), women seldom admit their abuse or seek help. But the more frequent the abuse, the higher the risk of damage. If the woman doesn’t make a change, abuse becomes increasingly lethal.
Most abuse is hidden. Bring it out into the open by asking if it is occurring, using matter-of-fact language at the initial and follow-up screenings. Encourage repeat visits, saying, ”I am concerned about you and would like to see you again soon.”
Abusers believe they are entitled to their behavior. They are not. Arrest is mandatory. The third arrest is an automatic felony.
Providers are unsure of what to say when abuse is revealed. Use Information Cards and have referral phone numbers handy. It only takes a few minutes to acknowledge the situation, give the needed contact information and provide life-changing hope.
Victims fear losing children to DCYF or abandoning pets to harm. The Safe Families Collaboration Project requires absolute clarity about the risk to mother and child before reports to DCYF can be substantiated and acted upon. The Safe Pet Program provides immediate shelter for pets.
While there may be many layers of barriers to leaving an abusive relationship, there are also many layers of support provided by medical, legal and community resources. Often all that’s needed to give a victim hope is empathy, recognition and the phone number of a hotline or resource center, so she knows there is a path to safety. It can help her to know that police will intervene, get her to safety and arrest the abuser, and that she has up to three years to file a police report.
Steps on the path include:
1. Doctor’s office or ER These providers are uniquely placed to identify IPV at earliest stages and intervene with referrals to hotlines, community resource centers, police and court advocates.
2. Hotlines Operated 24/7, trained responders provide an immediate lifeline to help, resource centers and police intervention.
3. Resource Centers In RI, Day One provides immediate response to trauma and assault. Resource Centers around the state will always find shelter and a bed for a woman (and her children) who seek immediate safety.
4. Police Special Victims Unit 401 243 6236. Providers have great influence on directing victims to call law enforcement, whose intervention is often vital in breaking cycles of violence. Police help the victim get to safety or medical treatment, and must by law arrest the perpetrator (the abuser or person who has the most power in the relationship.)
5. Advocates These trained professionals advocate for women through the legal system and court process, i.e., how to obtain a restraining order or press charges. Advocates work from police stations and are available in every Rhode Island city and town.
Because stopping the lethality of abuse begins with identifying it early, recognize the critical role that providers play. Changes at the policy level in hospitals, clinics and private practices make a difference. These are the steps recommended by the Women & Infants Hospital’s Domestic Violence Team:
Identification, Intervention & Community Resources: Our most recent Critical Workshop Training on Intimate Partner Violence. The Women’s Health Council of RI invited providers meet with a range of IPV experts who taught participants how to identify, intervene, and provide community-based resources for women experiencing partner abuse. If you’d like more information now about recognizing and responding to Partner Violence, please visit this website provided by the Domestic Violence Task Force at Women & Infants Hospital.
5:30 – 6:00 PM Opening Comments
Welcome Constance A. Howes, JD WHC Mission and IPV
About IPV Amy S. Gottlieb, MD; Sarah C. DeCataldo Why we’re here
Panel Introduction Deborah DeBare, Facilitator Meet the range of IPV experts present
6:00-6:30PM Addressing IPV
Women’s Health Amy S. Gottlieb, MD Screening for IPV
Behavioral Health Margaret Howard, PhD Understanding mental health effects
Children’s Health Amy Goldberg, MD Kids who witness
6:30–7:10 PM Responses to IPV
Initial Assessment Sandra Shaw, MS, RN How to conduct an assessment
Safety Planning Jennifer Lang, MSW, LCSW Creating a safety plan
Resources Sarah C. DeCataldo, Day One Whom to call and what happens
Law Enforcement Detective Sgt. William Merandi Police and court response
7:10–7:30 PM The Window Forward
Systems-Based Change Amy S. Gottlieb, MD Creating institutional protocols
Patient Experience Yvonne Heredia, MSN, RN, CDOE Transition from victim to survivor
7:30-8:00PM Closing Q&A with Panelists
Mary Reich Cooper, MD, JD What did we learn?
Amy S. Gottlieb, MD, Workshop Co-Leader, is an Assistant Professor of Pediatrics at the Alpert Medical School of Brown University, and Attending Physician, Child Protection Program, Hasbro Children’s Hospital, Providence, RI. She is the Chair of Women & Infants Hospital’s Domestic Violence Task Force.
Sarah C. DeCataldo, Workshop Co-Leader, is the Legal Advocacy Services Coordinator for Day One, Rhode Island’s sexual assault and trauma resource center. Ms. DeCataldo coordinates the Sexual Assault Response Team (SART) and provides advocacy to victims throughout the criminal justice process. Additionally, Ms. DeCataldo coordinates and presents trainings on domestic violence, sexual assault and human trafficking to local law enforcement, hospitals, colleges and community agencies.
Deborah DeBare, MMHS, Workshop Facilitator, is Executive Director of the Rhode Island Coalition Against Domestic Violence, Warwick, RI. She is responsible for collaborative planning and statewide networking on behalf of the state’s battered women’s shelters. She also advocates for state and federal legislative initiatives affecting domestic violence issues.
Mary Reich Cooper, MD, JD, is a Senior Vice President and the Chief Quality Officer of Lifespan, and is an Assistant Professor of Medicine (Research) at the Alpert Medical School of Brown University. In her current position, Dr. Cooper is responsible for articulating the quality and safety strategy for Lifespan and working closely with the state government and quality organizations in Rhode Island to improve safety and quality of care for the citizens of Rhode Island. She is Co-Chair of the Women’s Health Council of RI.
Amy Goldberg, MD, serves as Attending Physician in the Child Protection Program at Hasbro Children’s Hospital, Providence, RI. She is Assistant Professor of Pediatrics at the Alpert Medical School of Brown University and actively engages with a number of community partners to improve recognition, response and prevention of child abuse and neglect.
Yvonne M. Heredia, MSN, RN, CDOE, serves as Adult Clinical Team Lead, Case Management at the Neighborhood Health Plan of Rhode Island, Providence, RI. She is CEO and founder of the Black Nurses Association, Inc. which promotes health and wellness to underserved populations in RI, and advancement of nursing leadership among minorities.
Margaret Howard, PhD, is the Director of the Postpartum Depression Day Hospital at Women & Infants Hospital, Providence, RI. She is also Clinical Associate Professor of Psychiatry and Human Behavior at the Department of Medicine, Alpert Medical School of Brown University. Dr. Howard has published and lectured widely on the topic of perinatal psychiatric disorders.
Constance A. Howes, JD, FACHE, is President and Chief Executive Officer of Women & Infants Hospital. She serves as chair of the Innovation Providence Implementation Committee. She is a member of the Board of Trustees of the Greater Providence Chamber of Commerce, a member of the Board of Directors of Day One, and a founding member of the Women’s Health Council of RI.
Jennifer E. Lang, MSW, LCSW, is a Clinical Social Worker in the Emergency Departments of Rhode Island and Hasbro Children’s Hospitals where she performs biopsychosocial assessments and screenings for abuse and neglect in adults and children. She also serves as Adjunct Faculty for Bachelor and Master level programs at Rhode Island.
Detective Sgt. William Merandi, is Commanding Officer of the Special Victims Unit, Providence Police Department, Providence, RI. His focus has been on improving the Department’s response to domestic violence and sexual assault, as well as investigating abuse in the elderly community. In 2010, Det. Sgt. Merandi formed the Domestic Violence TriageTeam which reduced the number of domestic violence homicides from 8 in 2009, to 2 in 2010.
Sandra M. Shaw, MSN, RN, is a faculty member of the VA Nursing Academy. In this role, she is a clinical instructor at Rhode Island College School of Nursing, teaching public health nursing with an emphasis on the care of veterans and their families. Formerly Health Services Coordinator for the Women’s Center of Southeastern Connecticut, she has helped providers develop their capacity for screening and responding to individuals living with domestic violence.
Constance A. Howes, JD introduces the the Women’s Health Council of RI workshop.
Amy S. Gottlieb, MD presents statistics and information about Intimate Partner Violence.
Sarah C. DeCataldo describes the dynamics, of IPV and of power and control wheel.
Deborah DeBare, MMHS introduces Maria, a hypothetical patient. Each presenter hereafter builds on Maria’s story.
Amy S. Gottlieb, MD details the importance of IPV screening and interactions with patients.
Margaret Howard, PhD describes non-judgmental, empathic screening and non-verbal cues to notice.
Amy Goldberg, MD discusses the impact on children who witness or experience IPV.
Sandra M. Shaw, MSN, RN discusses the content and importance of initial assessment for IPV.
Jennifer E. Lang, MSW, LCSW discusses creating a safety plan for victims/survivors of IPV.
Detective Sergeant William Merandi describes law enforcement responsibilities around IPV.
Amy S. Gottlieb, MD details how a systems based approach can improve the health care response to IPV.
Yvonne M. Heredia, MSN, RN, CDOE speaks about the transition from victim of IPV to survivor.
Intimate Partner Violence Risk Markers: Aimee Thompson – From Close 2 Home, a non-profit organization that has reduced the amount of domestic violence and increased the number of healthy relationships in a Boston neighborhood and around the world.
Intimate Partner Violence 1: Amy S. Gottlieb, MD – Definition and statistics show that the results of what we are doing is disappointing.
Intimate Partner Violence 2: Sarah DeCataldo – Understand the dynamics of abuse before you can properly screen patients.
Intimate Partner Violence 3: Amy S. Gottlieb, MD – Make asking about IPV routine. Use scripting for best results because women usually don’t disclose during a one-time encounter.
Intimate Partner Violence 4: Margaret Howard, PhD – Importance of repeat screening. Red flags: depression, anxiety, self-medication, low self-esteem.
Intimate Partner Violence 5: Amy Goldberg – ChildSafe program. How to assess the caregiver’s protective capacity.
Intimate Partner Violence 6: Sandra M. Shaw, MSN, RN – Role of the screener.
Intimate Partner Violence 7: Jennifer Lang, MSW, LCSW – Language for creating a comprehensive safety assessment and plan.
Intimate Partner Violence 8: Sarah DeCataldo – Resources for survivors and the path of referrals.
William-Intimate Partner Violence 9: Detective Sgt. William Merandi – The role of law enforcement as interveners.
Intimate Partner Violence 10: Yvonne Heredia – Recommendations from a survivor.
Intimate Partner Violence 1: Initial screening questions to use before a patient has disclosed that they are being abused, because providers have great influence in directing a victim to places for intervention.
Intimate Partner Violence 2: Follow-up screening and trust-building statements once a patient has disclosed that they are being abused.