Domestic Violence Screening in Medical and Mental Health Care Settings

ABSTRACT

Health care providers and patients agree that domestic violence presents a serious health issue that falls within the purview of medical care. The patient-physician encounter has the potential to assist domestic violence victims in considering their options of living without violence and playing a critical role in preventing future violence. Despite this possibility, many persons evaluated in the health care system do not experience the benefits of such interactions. This article reviews current research that evaluates physician, patient, and systems barriers to providing care to patients experiencing domestic violence as well as gaps in the current research and suggestions for how these barriers might be overcome. Educational initiatives, implementation of protocols, and increasing environmental cues that prompt patients and physicians to discuss domestic violence may all increase the likelihood of screening and the success of interventions.     

Understanding and Responding to Victims of Interpersonal Sexual Violence and Sexual Assault within Committed Relationships

Abstract

The purpose of this article is to increase therapeutic discussion surrounding intimate partner sexual violence (IPSV) by increasing understanding in how victims of IPSV perceive and respond to the assault. Although IPSV has received little research attention, sexual violence within relationships occurs at an alarmingly high rate. Theories of sexual assault, such as sex-role socialization, are discussed to aid clinicians in better identifying assaultive behaviors and common physical and emotional responses of victims. Additionally, the authors provide a framework for the assessment of IPSV and suggestions on “best practices” for creating conversations that promote hope and healing.     

Psychological MaltreatmentL

SUMMARY

Current issues regarding the definition of psychological maltreatment and its impact on children are discussed. The argument is made that psychological maltreatment can be understood as parenting and socialization practices that leave a child's basic psychological needs unmet, and that children exposed to interparental violence should be viewed as victims of psychological maltreatment. A needs analysis based on developmental theory and research is presented as a context within which to view psychological maltreatment. Using that conceptualization, research findings concerning the behavioral, cognitive, and social-emotional difficulties of children exposed to marital violence are examined. Based on this developmental analysis, recommendations are made regarding research that is needed in the areas of these children and psychological maltreatment.     

Future Directions in Intimate Partner Violence Prevention Research

ABSTRACT

During the past 20 years, research on dynamics of intimate partner violence, risk factors, and treatment of intimate partner violence has flourished. However, research on the prevention of intimate partner violence is in its infancy. The current volume was developed in order to examine the state of the art in preventing intimate partner violence. To that end, this article offers a synthesis of recommendations for future research made by the authors in this volume and participants in the symposium on the prevention of intimate partner violence sponsored by the Department of Defense. A goal in compiling these recommendations is to foster more and better research into preventing intimate partner violence.     

Analysis of early representations and personality among victims of domestic violence

IntroductionThis exploratory study analyses the individual elements of the victims of domestic violence through life events, early dysfunctional representations and personality.ObjectivesThis research aims, firstly, to show the existence of early traumatic experiences for the victims of domestic violence. Secondly, it aims to measure the prevalence of early maladaptive schema and identify personality traits in these subjects. Finally, our aim is to highlight that depending on the violence carried out within the couple (reciprocal/unilateral), activated schemas and personality traits are different.MethodOur sample consists of 80 female subjects, non-abused women (n = 40) and victims of domestic violence (n = 40), of which 22 victims of unilateral violence and 18 victims of reciprocal violence. Participants filled out an initial questionnaire as well as the scales and self-report questionnaires as follows: Life events (Amiel-Lebigre, 1984); TCI (Cloninger et al., 1993); YSQ-S3 (Young et al., 2005). The data were subject to statistical analysis and were processed using the software SPSS 22.ResultsThe results show that the victims have experienced more early traumas than non-victims, that schemas (emotional deprivation, mistrust and abuse, subjugation, self-sacrifice) are more active. We note also different personality traits according to the different groups (victims/non-victims) and subgroups (reciprocal violence/unilateral violence).ConclusionOur study sheds light on the role of the individual elements of the victims on the perception of the relationship and on the process of engagement and disengagement of women in abusive relationships. Limits and expectations of the study are discussed.     

Domestic Abuse Across the Lifespan

ABSTRACT

Domestic abuse has reached epidemic proportions in the United States. Occupational therapists working in many different settings will encounter children, adults, elders and individuals with disabilities who have experienced intimate violence and abuse. This article presents common definitions and illustrative examples of each type of violence. Issues related to the difficulty inherent in identifying victims of abuse are discussed with an elaboration of indicators that are likely to be seen by an occupational therapist in the clinical setting. Risk factors for becoming a victim or an abuser for each population group and the effects of violence on victims are presented. A brief discussion of the legal and ethical implications of identifying and treating abuse victims concludes the article.     

Beyond Resilience: Glimpses into Women’s Posttraumatic Growth after Experiencing Intimate Partner Violence

Abstract

Little focus is given to the pathways victims of intimate partner violence (IPV) use to move toward posttraumatic growth. A sample of 32 female participants was recruited through advertising in domestic violence shelters. Women were interviewed about their experiences with four main themes emerging from women’s narratives related to posttraumatic growth: deliberateness of action, ending the cycle for the children, a changed perspective on life, and alternative perceptions of social support. Opportunities for professions working with this population in a number of various of settings is presented to promote long-term changes for women affected by IPV.     

« Docteur,pourrais-je avoir une copie du certificat ? » Étude pluricentrique concernant l’application des décrets du 31 mars 2021 et du 23 novembre 2021

On 31 March 2021, a decree was published in the Official Journal concerning the procedures for the delivery of medical certificates to victims of violence. These victims can now obtain a copy of the certificate drafted by the doctor required by the judicial authorities, particularly as regards medical examiners.PurposeThe aim of our study was to assess the impact of the March 31, 2021 decree on victims’ requests to the medical examiner for a copy of the medical certificate.MethodsThis prospective study was conducted among three forensic services receiving victims in consultation, using a paper questionnaire linked to Medlé data, over a three-month period.ResultsOf the 1,492 consultations conducted during the study period, a copy of the certificate was only given to the victim in 13.1 % of the consultations. It was requested spontaneously by the victim in 15.2 % of cases, most often to exercise his right (46.4 %). These were primarily consultations following an accident, psychological abuse, and assault. This copy was requested spontaneously by less than 3 % of victims of domestic violence. There was some disparity between the three centres regarding the minor victim.ConclusionThis study is a small sample over a short period. The information of the victims, especially of domestic violence, on access to the copy of the medical-legal certificate seems still insufficient, and the principle of surrender, when it can help the victim in his efforts, can also be a source of confusion.     

Intimate Partner Violence and Drinking among Victims of Adult Sexual Assault

Intimate partner violence (IPV) is associated with problem drinking. Correlates of alcohol consumption frequency and problem drinking were examined among female sexual assault survivors (N = 1,863). Data were analyzed with blockwise multiple regressions. Results show heavy alcohol consumption and problem drinking were associated with IPV history, sexual assault by strangers or acquaintances, and maladaptive coping. Physical IPV history and partner sexual assault showed distinct effects on drinking outcomes among women. Physical IPV history partially mediated the effect of childhood sexual abuse (CSA) on problem drinking. Research is needed to examine the relationship between victimization histories and drinking among female sexual assault victims. This might enable treatments and interventions to be tailored to the trauma histories of female victims.     

Involving Police Departments in Early Awareness of Concussion Symptoms during Domestic Violence Calls

ABSTRACT

Police officers around the world respond to and investigate calls regarding domestic violence (DV) daily. Police departments operate with standard protocols, particularly when engaging in investigations that involve allegations of strangulation or sexual assault. Operating under advisement of the Maricopa County Attorney’s Office, the Mesa Police Department (Mesa, AZ) has established protocols for detecting, recording, and prosecuting DV cases that involve strangulation and sexual assault. Allegations of strangulation (defined as impeded breathing) or sexual assault prompt officers to offer a forensic nursing exam (FNE) combined with strangulation treatment by forensic nurses at the Mesa Family Advocacy Center. Recognizing the potential for head injury to the assault victim in all DV situations, including intimate partner violence (IPV), the police department has added concussion-awareness training, as well as a point-of-incident investigative tool for its officers to record neurological function of the victim. Officers were instructed to use the ConQVerge device to measure and record the Near Point of Convergence (NPC) as a test of neurological impairment in suspected head injuries. In this article, we discuss the challenges and opportunities for assisting victims of DV strangulation and sexual assault (including non-DV sexual assault) with on-site assessment and consent for further medical assessment and treatment. Additionally, rates of domestic assault victims that report a crime, but decline to follow through with forensic medical tests, are reported for the first time. Lessons learned from the project that inform strategic operations in this space are offered to other agencies prior to the implementation of similar procedures.     

The Power of Shame

Abstract

The reality of lesbian partner violence has been long under-recognized and misunderstood. Treatment protocols based solely upon work with heterosexual batterers and victims are inadequate when working with lesbians. In fact, without recognizing the specific needs of lesbians, treatment may compound rather than cure the problem. This article explores lesbian battering as a response to and reenactment of cultural oppression, internalized homophobia, and religious/psychological shame. The cycle of domestic violence can be the acting out of the traumatization of homophobia/heterosexism, compounded by sexual and religious shaming. A theology of liberation and the psychology of healing from trauma are explored as critical ingredients to treating victims and perpetrators.     

Teaching Violence Prevention

Summary

This paper defines violence from a Public Health perspective. It offers recommendations for creating a curriculum to teach health professionals about the critical issues involved in establishing a more peaceful society. Specific learning objectives, teaching methods, and examples of group discussion activities are presented, as well as an extensive bibliography. The intention is to make available to health professionals information that promotes an understanding of the overall impact of violence in our society, and specific skills in the recognition and management of victims of violence. Because of the importance of domestic violence as the center of the web of violence in our culture, emphasis is placed on understanding the dynamics and effects of this specific form of violent behavior. Teaching violence prevention occupies a critical role for medical education.     

The Family Peace Project

Summary

Intimate partner violence-assault by a spouse, ex-spouse, intimate friend or ex-friend-is the most common cause of injury for women and a serious public health problem. As a result, the American Medical Association has recognized physicians' ethical obligation to diagnose and treat partner violence, and called for new models of training. In this article, we review literature on the health care system's response to domestic violence. We then describe the Family Peace Project, a community oriented model for training health care professionals to identify, treat and prevent partner violence in primary health care settings. This training program provides knowledge, clinical skills and a sense of professional empowerment. Unique features of this program include: involvement of community mentors (survivors of family violence) as program faculty; training in specific clinical skills and protocols for screening, assessment and intervention; a hands-on assessment of community resources; coinmunity service; and, creation of an award winning web site to promote dissemination of the training program.     

An Underserved Population and Untapped Resource: A Preliminary Study of Collegiate Sorority Response to Dating Violence

ABSTRACT

To what extent do national collegiate sororities have formal programs and policies addressing dating violence? Given that undergraduate women are at high risk for violence by a male partner, sororities represent an opportunity to reach large numbers of undergraduates as well as women in the community who are active in alumni chapters. Based on a telephone survey and review of organizational Web sites, study results suggest that collegiate sororities are an underserved population with regard to prevention, education, and outreach services and an untapped resource with regard to opportunities for community service. Suggestions for building collaboration between sororities and service providers to raise awareness, support victims, create safety planning, and develop resources are addressed.     

Intimate Partner Violence (IPV) and Neurological Outcomes: A Review for Practitioners

ABSTRACT

Thirty-eight million women will experience intimate partner violence (IPV) during the course of their lifetime. Many of these women will experience brain injuries as a result of IPV and may not seek medical attention. Several types of practitioners who work with IPV survivors consistently, e.g., first responders, advocates, and clinicians, may be unfamiliar with brain functioning, screening, assessment, and treatment. This article reviews the dual traumas of IPV and TBI, the impact on neurological processes and symptomatology, and short and long-term outcomes. Recommendations for screening, intervention, interprofessional collaboration, and research are outlined.     

Psychological distress associated with domestic violence in Northern Ireland

Several studies have noted an association between domestic violence and psychological distress. However, little empirical work has examined behavioral and psychological difficulties, especially with reference to dissociation and guilt, in victims of domestic violence in Northern Ireland. In addition, childhood abuse history has tended not to be assessed in studies conducted in the Province. Using measures designed to assess behavioral and psychological difficulties that are problematic to self and/or others (that is, Brief Symptoms Inventory, General Health Questionnaire, Guilt Inventory), dissociation (that is, Dissociative Experiences Scale, Peritraumatic Dissociative Experiences Questionnaire) and trauma (that is, Traumatic Experiences Checklist), the current study assessed Northern Irish victims of domestic violence from shelter-type accommodation (N=33) and a comparison sample of women from the general population (N=33). The domestic violence group displayed significantly more psychological difficulties, including higher depression, anxiety and dissociation scores. Dissociative episodes at the time of an assault were related to higher on-going dissociative experiences. Finally, the domestic violence sample reported more emotional, physical, and sexual abuse in childhood than the comparison group. Despite the difficulty generalizing from victims of domestic violence in shelter-type accommodation to all victims of spousal abuse, the current results highlight the increased levels of psychological distress in those exposed to abuse by their partner.     

Research-Based Guidelines for Child Forensic Interviews

Abstract

We present important considerations for conducting forensic interviews with children who are witnesses to or alleged victims of crime. Specifically, we (a) present the basic principles of the forensic interview and review some of the best structured forensic protocols currently available; (b) provide a detailed, practical blueprint for conducting a structured forensic interview and emphasize how the components of the interview are based upon empirical research; and (c) discuss special con siderations for interviews with children of different age groups and children who have special needs or circumstances, and interviews involving various crime circumstances. We end with suggestions to assist legal and social service professionals in accessing the social science research literature that should inform forensic interview techniques.     

Children with Disabilities

Abstract

Children in out-of-home care due to abuse and neglect are at disproportionately high risk for disabling conditions. The reasons for the over-representation of children with disabilities in the child welfare system are reviewed and discussed in this chapter. Factors discussed include impact of abuse and neglect, the impact risk factors such as exposure to community and domestic violence and poverty, risk of abuse or neglect associated with disability, and child welfare system factors. In addition, the need for greater efficacy in identification of disability, identification of service needs, and linkage with and delivery of services to serve the needs of children with disabilities in out-of-home care is addressed. Recommendations for policy review at State and Federal levels are offered along with direction for future research.