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:
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.