DOMESTIC VIOLENCE IN FAMILIES WITH INCREASE RISK FACTORS

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DOMESTIC VIOLENCE IN FAMILIES WITH INCREASE RISK
FACTORS
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• What is domestic violence?
• The victimization of a person by one who has had
  an intimate, romantic or spousal relationship. In
  Windsor we also include family relationships

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What is it about?

• Domestic violence is about power and control. One
  persons power and control over another.
• These behaviours may exists alone or in
  combination with other forms of violence. Such as
  slapping the spouse and/or kicking the spouses
  dog.

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Forms of abuse

• Physical violence - this is what most people
  believe is abuse
• Financial abuse - controls how much money they
  have or can spend at any given time
• Psychological abuse - threats of physical harm if
  they do not do as they are told. Threats of harm
  to another person. Intimidation, coercion,
  degradation and humiliation. Ridicule

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Forms of abuse continued

• Sexual Abuse - forced to perform sexual acts that
  they do not want to engage in - often times this
  occurs after physical abuse
• Pet Abuse - the abuser will abuse the pet of the
  spouse. Kicks the dog, sets fire to the cat or
  chokes the canary - what does this tell the
  victim?

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• Property abuse - the abuser breaks the victims
  possessions. Crime scenes that show all of her
  grandmothers dishes are shattered.
• The picture frame with her childrens pictures
  are smashed.
• What do you think is NEVER broken?

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Social Isolation

• Some victims of spousal abuse are isolated from
  all family and friends. They are not allowed to
  talk to anyone without the abuser being present
  for fear that she/he may tell.
• What problems could this pose for nurses in
  labour and delivery or the emergency department?

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Where can the victim go for help?

• Lynn Barkley Burnett (2001) cites a study where
  victims responded as follows
• would seek help from the police - 31.2
• Did not know - 27.7
• would go to a hospital - 14.7
• would approach a family member - 10.7
• would go to a shelter - 10.7
• would forgo help and simply retaliate - 3.1

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The ER

• Some women come to the ER with acute domestic
  violence. These are the women whose complaints
  are directly related to an incident of abuse.
• Easily 15 of the women seen in the ER due to
  injuries are there because of abuse and that
  includes MVAs.

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• Think about the women who come to the ER because
  of repeated headaches with no physiological
  reason found.
• The women who come to the ER with abdominal pain
  that cannot be diagnosed.
• The women who come to the ER with injuries that
  do not match the story she gives on how the
  injury occurred.

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How Can you Recognize domestic violence?

• You need to have a high index of suspicion - is
  the injury consistent with the story?
• Should the ER doctors and nurses be asking each
  patient about abuse?

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• There are many schools of thought on this.
• At present there is a study being conducted in
  Hamilton looking at indicator based screening
  versus screening everyone woman that comes into
  the ER about abuse.
• Do you see any problems with using just one or
  the other?
• Do you think you should only ask if there are
  visible injuries?
• What about the woman that comes in because of a
  headache? Is that Domestic Violence related?

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• Domestic violence crosses many lines and includes
  child abuse and elder abuse.
• Whatever you do to help a victim of domestic
  violence may also help any other victims that may
  be in the home or associated with the family and
  the abuser.

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Screening for violence

• Ask direct questions - do not ask if she is a
  victim of domestic violence because she probably
  doesnt realize that she is
• Ask - did someone hurt you? Did someone hit you?
• Do you feel safe at home?
• Is a past partner making you feel unsafe?
• Are you here today because of injuries from a
  partner?

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Cycle of Violence

• Tension building phase - the batterer is becoming
  increasingly angry - victim will try to be
  compliant so he will not abuse her - may find a
  victim that will be so frightened during this
  phase that she will precipitate the abuse just to
  get it over with

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Cycle of Violence cont.

• Acute Battering phase - this is when the abuse
  occurs - it can include hitting, slapping,
  punching, kicking, stabbing, pushing
• the victim may go for help after this phase and
  is often quite willing to talk about the abuse
  (as long as the abuser is not with her)
• Be careful when interviewing victim - who is she
  there with?

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Cycle of Violence cont.

• Honeymoon phase - no tension, no battering
• Abuser is very loving and will buy flowers etc.
  Promises he will never do this again. (even
  though she made him hit her)
• At this point the woman is less apt to ask for or
  accept any help. She believes that he will never
  hurt her again because she desperately wants to
  believe him.

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Why do they stay?????

• Love
• Dependence
• fear
• learned helplessness
• lack of self esteem
• ethnic background
• belief that he will change

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Love

• At least one partner in the relationship loves
  the other - she/he believes that the other loves
  them just as much and will change - this is easy
  for her to believe during the honeymoon stage
• she/he wants everything to be like it was at the
  beginning of their relationship

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Dependence

• Many women may have an emotional dependency on
  her partner and may not want to hurt him by
  telling what is going on and possibly seeing him
  go to jail
• financial dependence - he pays for everything
  even if she has a job - she gives him her
  paycheque and he gives her an allowance - usually
  not enough to buy groceries or things needed for
  the home

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Fear

• Very powerful motivator to stay
• feel that asking for help will increase the
  incidence of violence or escalate the violence
• have found this to be true
• the most dangerous time for a woman is when she
  is trying to or does leave the relationship
• SHE IS THE BEST JUDGE OF HER OWN SAFETY - SHE
  DECIDES WHEN SHE CAN LEAVE

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Learned Helplessness

• People exposed to unpredictable and inescapable
  problems may become passive and unable to protect
  themselves or their children.
• They have chronic anxiety, self-blame, passivity
  and paralyzing fear at the first sign of danger
• no fight or flight response

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How often does the abuse occur

• A study done by Dr. Peter Jaffe in London found
  that women will be beaten 25 to 35 times before
  they report the assaults to authorities
• Windsor and Essex County has a 100 femicide rate
• Cases such as the May/Iles inquest bring these
  problems to light across the province

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Problems you may encounter when interviewing
clients

• The batterer often comes with the victim to
  hospital - be careful when you are asking
  questions relating to abuse - the person doing
  the abusing may be there - not always the husband
  - could be brother or father
• batterer often hovers and will not leave the
  client alone so that questions can be asked or
  answers all questions for her

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Problems cont..

• Be sure to inform the client of any mandatory
  reporting requirements and explain about how
  confidentiality may be broken due to these laws.
  If she is pregnant you have 2 clients. Must
  report if children in the home
• if you must use a translator DO NOT use a family
  member but call the local Multicultural Society

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