Domestic Violence

I. WHAT IS DOMESTIC VIOLENCE?

Domestic violence is a crime in all fifty states. Defines domestic violence as “any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, false imprisonment, kidnapping, or any criminal offense resulting in physical injury or death of one family or household member by another who is or was residing in the same single dwelling unit”. Domestic violence may also be defined as a “pattern of controlling behavior by one person who has a personal, intimate or familial relationship with another.” (Governor’s Task Force on Domestic Violence, 2000).

The crime of assault is an intentional, unlawful threat, by word or act, to do violence to someone, coupled with an apparent ability to carry out such threat, creating a well-founded fear in the other person that violence is imminent. Aggravated assault is assault with a deadly weapon.

The offense of battery occurs when a person intentionally touches or strikes another person against their will or intentionally causes them bodily harm. Knowingly causing great bodily harm, permanent disability or disfigurement, using a deadly weapon, or committing battery against a pregnant victim is aggravated battery .

Anyone who willfully, maliciously and repeatedly follows or harasses another person, for no legitimate purpose, causing substantial emotional distress, commits the offense of stalking . Making a credible threat which causes someone to reasonably fear death or bodily injury either for themselves, their child, sibling, spouse, parent, or dependent, is aggravated stalking .

Kidnapping and false imprisonment mean forcibly, secretly, or by threat confining, abducting, or imprisoning another person against her or his will and without lawful authority.

Because violence inflicted by an intimate partner has traditionally been treated more leniently by law enforcement than violence inflicted by a stranger, domestic barterers are not always arrested.

On January 5, 2006, the President signed the “Violence Against Women” Reauthorization Act. This works though the use of STOP grants. As a result, “victims are safer, better supported by their communities, and treated more uniformly and sensitively by first-response workers.”

A. MYTHS ABOUT DOMESTIC VIOLENCE

Myths and misunderstandings about domestic violence abound. Although domestic violence occurs in approximately one out of three relationships , it remains one of the nation’s best-kept secrets. Domestic violence is the most under-reported crime in the country, with the actual incidence probably 10 times higher than reported. It remains a major health concern.

One prevalent myth is that perpetrators of domestic violence strike when angry and out of control. On the contrary, violence is an intentional choice, used to establish power and control in an intimate relationship. (Barterers manage not to beat their bosses or terrorize their friends when they are angry.) Domestic abuse is always about power and control . While the violence may not occur often, it is a constant underlying factor in the relationship. Although the first violent incident may not be severe, once battering begins, it tends to increase in severity and frequency, sometimes leading to permanent injury or death. The occasional slap or shove can evolve into a push down the stairs, a punch in the face or a kick in the stomach.

Another myth is that perpetrators are driven to violence by the behavior of their partners. In fact, perpetrators are unaffected by their partners’ efforts to change their behavior in order to appease them. The behavior the abuser chooses to target at any one time usually cannot be predicted by the partner, and this unpredictability is a major means for the banterer to maintain control.

B. SEXUAL ORIENTATION AND GENDER

Domestic violence is blind to sexual orientation or gender. It is not a heterosexual problem; domestic violence afflicts the same percentage of homosexual as heterosexual relationships. However, because some homosexuals have internalized the belief that domestic violence only occurs in opposite-sex relationships, they may not recognize domestic violence even as it is happening to them. A frequent obstacle impeding homosexual victims of domestic violence from seeking help is a perception, sometimes justified, of police and societal homophobia.

According to the U.S. Department of Justice (2005), 73 percent of domestic violence victims are women. However, many studies indicate that women are just as likely as men to physically attack their partners, frequently compensating for their smaller size and inferior strength by employing the element of surprise and by using weapons, including guns, knives, boiling water, bricks, fireplace pokers and baseball bats.

So, although crime statistics indicate large imbalances in the number of domestic violence incidents against men and women, this may result (at least in part) from the fact that an abused woman is many times more likely to report abuse than an abused man. Men are less likely to call the police, even when there is injury, because their shame about disclosing family violence is compounded by the shame of not being able to keep their partners under control. Moreover, the police tend to share these same traditional gender role expectations. As a result, police are frequently reluctant to arrest women for domestic assault. Women know this. As in the case of other crimes, the probability of a woman assaulting her partner is strongly influenced by what she thinks she can get away with.

C. THE COSTS OF DOMESTIC VIOLENCE

Domestic violence, also known as intimate partner violence or family violence, takes a profound toll on the family and on society. In addition to its devastating psychosocial effects, domestic violence is heavily implicated in rising health care costs, as well as increased absenteeism and decreased productivity in the workplace.

The Centers for Disease Control and Prevention (CDC) report that domestic violence affects more than 32 million Americans annually, causing more than 2 million injuries and approximately 1,300 deaths (CDC, 2005). Rape, incest and dating violence are all considered to be forms of domestic violence. Approximately 1.5 million women and more than 800,000 men are raped and/or physically assaulted by an intimate partner annually.

The term family violence also encompasses violence directed against children, and maltreatment of elders by spouses, children, other family members or other caretakers. Many older Americans, particularly women, are victims of family violence. According to the American Psychological Association (2007), each year an estimated 2.1 million older Americans experience physical, psychological or other forms of abuse, neglect or exploitation. About 80 percent of abused elders are women, and those over age 80 are the most frequent victims of abuse.

• Battering is the single major cause of injury to women, more frequent than auto accidents, muggings, and rapes combined.

• One in four female suicides is a victim of family violence.

• More police officers are killed trying to intervene on “domestic disturbances” than in any other area of duty.

• Two thirds of children who witness domestic violence among their parents later become the victims or perpetrators of domestic violence themselves.

• Abuse often escalates during pregnancy. Battered women are more likely to suffer miscarriages and to give birth to babies with low birth weights.

• Pregnancy may trigger or intensify domestic violence, particularly if the male partner is unemployed or sees the child as a rival for the woman’s time and attention. Violence occurs in up to 8 percent of pregnancies, and is particularly associated with unplanned pregnancy.

• Maternal mortality is three times as high for abused mothers, and abused African American mothers are four times as likely to die as their white counterparts.

• The risk of becoming a victim of domestic violence is highest among American Indian and Alaskan Native women and men, African American women, Hispanic women, young women, women who are separated or divorced, and women below the poverty line (Bureau of Justice, 2006).

• Sixty-three percent of the young men between the ages of 11 and 20 who are serving time for homicide have killed their mother’s abuser.

• Domestic violence accounts for 21,000 hospitalizations, 28,700 ER visits, and 39,000 medical office visits annually. (Maltar, 2003).

• Intimate partner violence against women resulted in more emergency room visits and hospitalizations than in cases where men were the victims (Arias & Corso, 2005).

II. TYPES OF ABUSE

Domestic violence is an abuse of power. It is the domination, coercion, intimidation and victimization of one person by another by physical, sexual or emotional means, within an intimate relationship. Abuse may be physical, psychological, or most frequently, a combination of both. Domestic violence is not only about hitting. Victims regularly report emotional and psychological abuse to be even more devastating than physical violence. Almost all physical violence is preceded and accompanied by emotional violence.

A. Physical

Slaps
Punches
Kicks
Choking
Shaking
Burns
Stabbing
Mutilation
Gunshot
Sexual

B. Psychological

Verbal harassment
Demeaning, name-calling
Ridicule
Intimidation
Threats of physical harm
Forced isolation
Unreasonable demands
Sexual jealousy
False accusations
Destruction of property
Giving away possessions
Harming pets

Power and control wheel

Abusive relationships are based on the mistaken belief that one person has the right to control another. Battering crosses all socioeconomic, educational, ethnic, sexual orientation, age, and racial lines in equal proportions. There is no “typical” victim.

Substance abuse is involved in about half of all domestic violence incidents. Although drugs or alcohol may lower a person’s self-control, they do not cause violence. Batterers often use drugs or alcohol as an excuse or permission to batter and to avoid responsibility for their abuse. Domestic violence and substance abuse are two different problems and each requires specialized intervention.

Batterers generally lead “normal” lives except for their unwillingness to stop their violent and controlling behavior in their intimate relationships. Batterers do not batter because they are crazy or mentally ill.

CHARACTERISTICS OF THE BATTERER

• Batterers come from any and all socioeconomic levels.

• Frequently grew up in a violent home.

• Low self-esteem and hidden depression.

• Poor impulse control.

• External locus of control-avoids responsibility for actions by blaming others.

• Difficulty building and maintaining close personal ties.

• Most often defers to persons in authority, able to portray a very different persona to the outside world.

• Frequently a traditionalist, believing in male supremacy and ownership of spouse and children: “king of the castle.”

• Exhibits “overkill” in activities and emotions, whether negative or positive, with unpredictable mood swings.

• Exhibits extreme jealousy, including verbal abuse about suspected affairs.

• Very controlling and monitors spouse’s every move.

• Obsessive about how things should be done in the home.

CHARACTERISTICS OF THE VICTIM

• From any and all socioeconomic levels.

• Frequently grew up in an abusive home.

• Has a history of repeated ED visits.

• Offers inconsistent explanations for bruises or fractures.

• Has “accidents” during pregnancy.

• Has psychosomatic and emotional complaints, such as sleeping and eating disorders, hyperventilation, choking sensations, chest pain, anxiety and depression.

• Embarrassed /evasive when questioned about injury or abuse.

• Offers apologies or excuses for the batterer’s behavior.

• Physical clues: multiple bruises in various stages of healing, dark sunglasses, heavy makeup, long sleeves, high collars.

• Appears anxious or fearful in the presence of abusive partner.

• Seldom has any cash and often “forgets” checkbook.

• May have a high degree of absenteeism at work.

F. THE CYCLE OF VIOLENCE

Domestic violence runs in a cycle. Typically, things are wonderful at the beginning of the relationship. Gradually, tension starts to build. Finally, an act of violence occurs, which may be verbal or physical. The victim is shocked. The relationship then moves into the “honeymoon” phase. The abuser is remorseful and attentive, and the victim wants to believe the abuse was an isolated incident. Again, the tension gradually builds until another violent act occurs. The longer the cycle goes on, the closer together the acts of violence become.

Battery

Phases:

Tension building : Constant arguing or “silent treatment”. May last from days to years.
Battery: Lasts minutes to days. Violence stops when victim leaves, police are called, or medical attention is needed.
Honeymoon : Abuser is apologetic, begs for forgiveness, and promises it will never happen again. This phase will eventually end and the tension will build again.

Characteristics:

Increased frequency: The more times the cycle is completed, the less time it takes to complete.
Increased severity: The longer the cycle when uninterrupted, the worse the violence gets.

G. “RED FLAGS” OF A BATTERING PERSONALITY

Many of the behaviors that society socializes us to interpret as caring, attentive, and romantic are actually early warning signs of the likelihood of future abuse. Behaviors to look for include the following:

Jealousy. An abuser will always say that jealousy is a sign of love. Jealousy has nothing to do with love; it’s a sign of possessiveness and lack of trust. In a healthy relationship, the partners trust each other unless one of them has legitimately done something to break that trust.

Controlling Behavior. Abusers will exhibit angry behavior if their partner is “late” coming back from the store or from an appointment. They may rationalize this behavior as arising from concern for the partner’s safety and well being.

Quick Involvement. Many domestic violence victims only knew their abuser for a few months or weeks before they started living together. The abuser may come on like a whirlwind, and abusers are generally very charming at the beginning of a relationship.

Unrealistic Expectations. Abusive people expect their partner to meet all their needs and to handle everything for them: emotionally, physically, and sometimes, economically.

Isolation. The abusive person tries to cut their partner off from all resources. The partner’s closeness to family may be derided as being “tied to the apron strings”. The abuser will accuse people who are supportive of their partner of causing trouble, and they may restrict their partner’s use of the car or phone.

Blaming Others for Problems. Abusers see themselves as victims and do not take responsibility for their own feelings or behaviors.

Hypersensitivity. Abusers are easily insulted, and may take the slightest setback as a personal attack. They will rant and rave about the injustice of things that are really just a part of living, such as having to get up for work, getting a traffic ticket, or being asked to help with chores.

Cruelty to Animals or Children. The abuser is a person who may punish animals severely and who is insensitive to their pain. He/she may be very critical of other people’s children or of any children the partner brings into the relationship. They may punish children to get even with their spouse. About 60% of people who beat their partner also beat their children.

“Playful” Use of Force in Sex. This kind of person may like to act out fantasies where the partner is helpless, expressing the idea that rape is exciting. They may show little concern about whether or not their partner wants to have sex, using sulking or anger to manipulate them into it. They may initiate sex while the partner is sleeping, or demand it when they are ill or tired. They may want to “make up” by having sex after they have just been physically or verbally abusive.

Verbal Abuse. The abuser will say things that are intentionally cruel, and will degrade, curse or belittle the victim’s accomplishments.

Rigid Sex Roles. Abusers expect their partner to play the “female” role, to serve them and obey them in all things.

Dr. Jekyll and Mr. Hyde. Many victims are confused by their abuser’s sudden changes in mood, and may think it indicates a special mental problem. Abusers may be nice one minute and explode the next. Explosiveness and moodiness are typical of people who beat their partners. Many victims feel that if their partner would just quit drinking or using drugs, the violence would stop. This is usually not the case. Abusive people continue the abuse even after they stop using alcohol or drugs, unless they also seek help for their abusive behavior.

Past Battering. These people say they have hit a partner in the past, but the previous partner made them do it. You may hear from relatives or ex-partners that the person has been abusive. A batterer will beat any person they are with if the relationship lasts long enough for violence to begin; circumstances do not turn a person into an abusive personality.

Threats of Violence. Most people do not threaten their mates. However, a batterer will say, “Everyone talks like that” or “It didn’t mean anything”.

Breaking Objects. The abuser may beat on the table with their fist or throw objects around. This behavior is used as punishment and to terrorize the victim into submission.

Use of Force During an Argument. A batterer may hold their partner down, restrain them from leaving the room, push or shove them. They may pin them to the wall, saying, “You’re going to listen to me!”

H. WHY VICTIMS STAY

It is a myth that people don’t leave violent relationships. Many leave an average of five to seven times before they are able to leave permanently. Violence can escalate by up to 75% when victims try to leave, and threats are often made against the children.

People stay with abusive partners for many different reasons, including the following:

Fear

• The victim fears being beaten more severely. The batterer may have threatened to find and kill or harm their partner, their children, or their family should the partner leave.

Financial Dependency

• Dependency on the batterer for shelter, food, and other necessities.

• Perceived inability to care for self and children alone.

• Frequently not permitted to work-lacks job skills.

• Frequently not allowed access to money.

Poor Self-image

• “With my looks, age, personality or income, this is as good a relationship as I’ll ever be able to get”.

• Loss of self-respect and confidence in abilities due to ongoing abuse.

Impaired Perceptions

• “It isn’t that bad”.

• “It’s my fault. If I’d just done X, this wouldn’t have happened”.

Emotional Dependency/ Reluctance to Give Up the Good

• At times the batterer is loving and affectionate.

• Desire to stand by one’s partner and be loyal to the relationship.

• Partner has threatened suicide if the victim leaves.

• Victim hopes by staying to “save” the batterer and help him/her get better.

No Place to Go

• Isolated from friends and family.

• Lacks information on shelters.

• Waiting list to get into shelters.

Religious/Cultural Beliefs

• Belief that children need two parents.

• Desire to keep the family together and live up to a religious commitment.

Shame

• “What will my friends, family, colleagues, neighbors think?”

Denial / Inertia

• “I’m not ready for that much change in my life.”

• Force of habit. “I’m used to life the way it is now.”

• “All I have to do is leave the house until he/she cools down.” (That’s what TV star Phil Hartman said, before his wife murdered him and killed herself.)

III. HELPING AND REFERRING VICTIMS AND PERPETRATORS

Since domestic violence occurs in approximately one out of three intimate relationships, both heterosexual and homosexual, chances are great that a health care provider will encounter both victims and perpetrators of domestic violence on a routine basis. It is thus extremely important for the good of the community that providers develop well-honed diagnostic assessment skills in order to identify and assist both victims and perpetrators.

health care providers may think, “There is nothing I can say or do to help.” Yes, there is! Health professionals can break the cycle of domestic violence by providing opportunities for patients to discuss violence and by making appropriate referrals for both victims and perpetrators. health care providers must realize that ignoring domestic violence is essentially an act of collusion with the perpetrator and is not a neutral action. The price of not intervening may be preventable death, serious injury, or persistent mental and physical health problems. One general practitioner reported that he found that wearing a button stating his personal opposition to domestic violence dramatically increased his patients’ willingness to discuss the issue.

For reasons of safety, the issue of domestic violence should not be raised with a perpetrator without the consent of the victim. It is important to keep full clinical records in these complex situations, noting clinical reasons for actions taken. Confidentiality issues are especially difficult when the victim continues to be at risk but does not want the provider to raise the issue of domestic violence with the perpetrator and does not want police intervention. Forcing interventions on unwilling patients is a violation of the ethical principle of respect for patient autonomy. Victims may prohibit intervention by health care professionals because they fear (often with justification) that it will make their situation worse. The provider may be able to do no more than offer support and education for victims until the victims themselves judge that the time is right to make a move.

The following list of “Things to Say that Are Very Helpful to a Victim,” is from Sarah Buel’s “The Dynamics of Family Violence:”

• I am afraid for your safety.

• I am afraid for the safety of your children.

• It will only get worse, never better.

• We’re here for you when you are ready / able to leave.

• You deserve better than this.

• Let’s figure out a safety plan for you.

A. HOW TO CONDUCT A DIAGNOSTIC INTERVIEW

Use your ” RADAR :

R outinely screen all patients

A sk direct questions.

D ocument your findings.

A ssess patient safety and that of the children.

R eview options and referrals.

All health care providers need to be alert to the possibility of domestic abuse in patients of every age, race, gender and socioeconomic group, and need to screen routinely for potential domestic violence. health care providers should be alert for signs and symptoms of family violence, such as:

• Delay in seeking care

• Missed appointments

• Vague or inconsistent explanation of injuries

• Nonspecific somatic complaints

• Depression and social isolation

• Substance abuse

During the appointment, be aware of lack of eye contact and/or an intimate partner who is reluctant to leave the patient alone with the health care provider. Victims of abuse may appear fearful, anxious, withdrawn, angry, unresponsive or afraid to talk openly. Suicide attempts may be directly related to intimate partner violence.

During the physical examination, look for injuries on many areas of the body, especially the face, throat, neck, chest, abdomen and genitals. Note any bruises, burns or wounds shaped like objects such as teeth, hands, belts, rings, or cigarette tips. Note any pain from touching. Be alert for puncture wounds, fractures and dislocations, scars on the vulva or rectum or any unexplained vaginal or anal bleeding, particularly in older people. Be aware that the victim may wear a glove or sock to conceal a scalded hand or foot.

Accurate, thorough documentation of the patient’s injuries is essential in cases of suspected abuse, because it can serve as objective, third-party evidence useful in legal proceedings. For example, medical records can help victims obtain a restraining order to qualify for public housing, welfare, health and life insurance and immigration relief.

To be admissible in a court of law, medical documentation should include the following (Isaac & Enos, 2001):

• Photographs of the injuries, taken during the initial examination.

• Body maps, which document the extent and location of the injuries.

• Description of the patient’s demeanor (crying, angry, agitated, upset), including a record of the patient’s comments about how the injuries occurred. The patient’s own words should be set off in quotation marks or identified by such phrases as “the patient states” or “the patient reports.”

• Any description in which the patient identifies the abuser, such as “my boyfriend kicked me.”

• The time of day when the patient is examined and, if possible, how much time elapsed since the injuries occurred. For example, “patient says that last night his wife hit him with a shoe.”

• Legible handwriting. Too often, doctors’ or nurses’ poor handwriting on medical records makes the documentation inadmissible as evidence.

Health professionals should avoid any phrases – such as “patient claims” or “patient alleges” – that cast doubt on the patient’s veracity. Also avoid legal terms such as “alleged perpetrator” or “assailant.” Do not use conclusive terms such as “assault and battery” or domestic violence” in documenting a case; let the factual information in the record speak for itself.

B. SCREENING QUESTIONS FOR VICTIMS

• Can you think of a time when your partner grabbed you or prevented you from leaving a room?

• Can you think of a time when your partner pushed or shoved you?

• Can you think of a time that your partner hit you?

• Does your partner manipulate you to have sex if you don’t want to?

• Has your partner ever forced sex on you?

• Are you put down or criticized?

• Do you ever feel you just can’t do anything right?

• Do you spend a lot of time trying not to upset your partner?

• Are you afraid of your partner?

• Has your partner restricted you from doing what you want (such as spending time with family or friends, taking a job, engaging in a hobby outside the home)?

• Do you have any money of your own to spend? Who handles the family finances?

Questions NOT to ask:

• Why don’t you just leave him/her?

• What did you do to make him/her so angry?

• SCREENING QUESTIONS FOR PERPETRATORS

Perpetrators also need help, although their behavior is much less likely to elicit compassion or understanding. Few perpetrators identify domestic violence as their problem. They tend to minimize their violence or deny it altogether, and their behavior is notoriously difficult to change. The majority of those who do present are in a situation of crisis. They may have been directed by a court to attend a rehabilitation course, or their partner may be threatening to leave or have already left the relationship. Other clinical situations that may alert the provider to the possibility of partner abuse include drug- and alcohol-related problems, stress-related situations and depressive illness, a past history of childhood abuse or any new relationship where stepchildren are involved. In managing these time-consuming and often stressful consultations, consideration for the safety of victims and children must be paramount.

Be direct, starting with broad questions before becoming more specific. Ask how disagreements or situations of conflict are resolved, before inquiring whether hitting or isolating actions are part of this. (For example, “Do you find you want to hit her to make her see reason?”)

• Focus on the abusive conduct, not on the explanations or rationalizations, and make the connection between the perpetrator’s behavior and the victim’s injuries. (For example, “When you hit him on Saturday night you broke his nose. This is a criminal offense and there are consequences. You need to make some changes and we need to consider some things you could do.”)

• Help the perpetrator to see domestic violence as a health care issue and to understand that it negatively affects him/her as well as his/her partner and children. Ask what effect (s)he thinks his/her violence has on his/her partner and children, and how it might change their relationship.

• Discuss options for treatment and referral. These could include referral to accredited behavioral change programs or to therapists who have expertise in domestic violence counseling.

D. HELP FOR BATTERERS

Perpetrator programs are designed to help batterers change their behavior and to develop respectful, non-abusive relationships. The emphasis is on taking responsibility for violent and abusive behavior, without minimizing it or blaming others. Perpetrators learn that they are in control of their own behavior and can choose not to be violent. It is important that they understand the impact of violence and abuse on their partner and their children. They learn different, non-abusive ways of dealing with difficulties in intimate relationships. Changing behavior is a long-term process, especially for someone long habituated to the use of violence and other forms of abuse. Batterers are most frequently motivated to change their violent behavior when they are brought to recognize its destructive impact on their children. A useful approach to take with some perpetrators is to explain how persistent fear and threats of violence can adversely affect physical, emotional, behavioral, cognitive and social aspects of a child’s development.

Domestic violence has been a fact of life for millennia and we should not be overly disheartened by the difficulty of bringing about change. Behavior is difficult to alter, and relapse into previous damaging patterns of interaction is common. The role of health care professionals is to be fully informed, clear in understanding the destructive nature of domestic violence, and to be available over time to facilitate change for perpetrators and victims.

Equality wheel

SAFETY TIPS FOR VICTIMS WHO LEAVE THEIR ABUSER

1. Have an escape plan:

• The best time to leave is during the “honeymoon” phase, when violence is at a minimum. Remember that the violence escalates considerably when the victim leaves. The abuser is also least likely to suspect it during this time.

• Keep extra money in a safe place.

• Make copies of important papers (i.e., insurance forms, birth certificates, etc.) and house and car keys. Leave the originals!

• Keep these copies and a suitcase packed with necessities at a friend’s house.

• Confide in a neighbor, friend, or relative, asking them to be available for temporary assistance on short notice. Select the least obvious person . If needed, contact the 24-hour Domestic Violence Hotline to receive help with shelter.

• Victims with children should take the children with them, to prevent their being abused or held hostage by the abuser.

2. Take what you need:

When you leave , try to take as many of the following items as you can. You may not be able to go back for these things later:

Driver’s license
Birth certificate(s)
Money
Title to your car
Lease/rental agreement/house deed
Checkbook
Credit cards
Insurance papers
Keys
Medications
Small salable objects
Address book
Pictures
Medical records (for the whole family)
Social security card
Work permits
Green card
Passport
Divorce/separation papers
Jewelry

You may take anything that belongs to you alone and anything that belongs to you and your partner together. You can withdraw money you have in a joint bank account with your partner. You may not take anything that belongs only to your partner and you may not destroy property that belongs to both of you.

3. When you have moved:

• Alter your routine and travel routes.

• Be alert to the possibility of being followed.

• Do not go to familiar shopping places or social spots.

• Consider renting a post office box for your mail or using the address and phone number of a friend.

• If possible, change your working hours and if necessary, the school or daycare your children attend.

• Inform your boss and the children’s school of the situation, making sure they understand that your children are not to be released to anyone except you. (Until one parent gets a temporary custody order, each has equal rights to the children.)

• If there is a court order in place, train the children to call 911 to report any violations.

• You may access www.ncadv.org, the website of “The National Coalition Against Domestic Violence”, to print out a safety plan.

F. LEGAL PROTECTION FOR VICTIMS OF DOMESTIC VIOLENCE

State law (741.30, F.S.) provides for the issuance of an injunction for protection for victims of domestic violence or persons who have reasonable cause to believe they are in imminent danger of becoming victims of domestic violence. (Helpful hints: Provide as much proof as possible (e.g., pictures of injuries, medical records, witnesses of abuse, etc.). Such persons must file a petition for an injunction for protection in the circuit where they or the respondent reside or where the domestic violence occurred. There is no residency requirement and no fee.

As determined by the court, an injunction for protection can:

• Order the abuser not to commit any acts of violence against their partner, their children, or others living with them.

• Order the abuser to be barred from any contact with the victim.

• Order the abuser to leave the home they share with the victim.

• Grant temporary custody of any children to the victim.

• Order the abuser to go to counseling.

• Order the abuser to give any guns to the police.

An injunction for protection may be obtained by:

• A spouse or ex-spouse of the abuser.

• A relation by blood or marriage of the abuser.

• Anyone who has lived as a family with the abuser.

• Anyone who shares a child with the abuser.

To make the most effective use of an injunction for protection, victims of domestic violence must:

1. Get a certified copy of the court order.

2. Have the court order with them at all times.

3. Give copies of the court order to family members, their boss, the school or daycare their children attend.

4. Enforce it! Call 911 immediately if the abuser violates the order.

IV. ELDER AND CHILD ABUSE

Child and elder abuse are serious social problems in this country, and frequently these cases first come to light in EDs or medical offices. 872,000 children in the United States were victims of child abuse or neglect in 2004. Multiple fractures, spiral fractures and fractures in various stages of healing should raise flags; so too, should abdominal bruises or serious abdominal injury in the absence of accidental trauma. Also be alert for retinal hemorrhages, which could indicate shaken baby syndrome.

Ask the person who brought the child in how and when the injury occurred. A story that doesn’t match the extent of the injury should arouse suspicion, as should a delay in seeking care or conflicting accounts by the people involved. Basic questions to ask are: What was the date and time of the injury and when was it first noted? Where did it occur? Who witnessed it? What was happening prior to the injury? What did the child do afterward? How long did the caregiver wait before seeking treatment for the child? If the child can talk, get his or her account of the incident, as well. If you suspect an intentional injury, examine the child completely, undressing them to assess for hidden bruises or marks.

Reports to Adult Protective Services (APS) agencies of domestic elder abuse increased 150 percent between 1986 and 1996, even though the older population increased by only 10 percent (Administration on Aging, 2001). Older women in abusive situations are the least likely to report the abuse, primarily due to social and cultural values.

Media reports give the erroneous impression that elder abuse occurs primarily in nursing homes, but research indicates that most abuse and neglect of elders occurs at home. Most of the time, the perpetrators are spouses or family members (National Center on Elder Abuse, 2002). The abuse may be intentional or unintentional, due to lack of knowledge or lack of ability or desire to provide proper care. Families stressed by illness, unemployment, alcohol and/or drug use are more likely to experience violence. This is particularly true with elder abuse, especially if the older person is frail or mentally impaired, the caregiver is ill prepared for the task, or if needed resources are unavailable. Adult children who abuse their parents frequently suffer from mental and emotional disorders, alcoholism, drug addiction, and/or financial problems that make them dependent on the parents for support.

V. STATE REPORTING REQUIREMENTS

State is 1 of 10 states having participated in the Family Violence Prevention Fund’s health care initiatives since 1995. These initiatives have resulted in important policy changes concerning reporting domestic violence, training reforms, public education, and outreach into diverse and underserved communities. State now requires health practitioners to take a two-hour domestic violence education course as part of every third relicensure or recertification

State statute 790.24 requires health care providers knowingly treating anyone suffering from a gunshot wound or life-threatening injury indicating an act of violence, or receiving a request for such treatment, to report the same immediately to the sheriff’s department of the county in which said treatment is administered or request for treatment is received. A health care provider willfully failing to report such treatment or request for treatment is guilty of a first-degree misdemeanor.

State law classifies people with disabilities who may be unable to adequately provide for their own care and protection as vulnerable adults . A vulnerable adult is defined (Chapter 415, F.S.) as someone “age 18 or older whose ability to perform the normal activities of daily living, and/or to provide for his or her own care or protection, is impaired due to a mental, emotional, long-term physical, or developmental disability or dysfunctioning, or brain damage, or due to the infirmities of aging”. All health care professionals, including employees of long-term care facilities, are required to report suspected abuse, neglect or exploitation of such persons to the State Abuse Hotline of the Department of Children and Families: 1-800-962-2873.

Chapter 39 of the State statutes mandates that any person who knows, or has reasonable cause to suspect, that a child is abused, abandoned or neglected by a parent, legal custodian, caregiver or other person responsible for the child’s welfare shall immediately report such knowledge or suspicion to the State Abuse Hotline (see phone number listed above). All health care professionals are required to provide their name to the hotline staff. The name of the person reporting shall be entered into the record of the report, but shall be held confidential.

The health care professional should discuss mandatory reporting requirements with those involved prior to screening.