Presented at Healthy Mothers, Healthy Babies conference, June 2013.

1. FamilyFamily
Violence:Violence:
A GrowingA Growing
Public HealthPublic Health
ConcernConcern
Mary M. Conklin, JD, MSN, RNMary M. Conklin, JD, MSN, RN
Margaret M. Gorman, PhD, RNCMargaret M. Gorman, PhD, RNC
mconklin3615@sbcglobal.netmconklin3615@sbcglobal.net
mgorman@madonna.edumgorman@madonna.edu

2. Domestic ViolenceDomestic Violence

3. Who is Family?Who is Family?
 A spouse or former spouse
 Someone with whom the person resides
or has resided
 Someone the person has or had dated
 Continued…….

4. Who is Family?Who is Family?
 Someone the person is or has had a
sexual relationship
 Someone who is related or was formerly
related to by marriage
 Someone with whom the person has a
child

5. What is Abuse ?What is Abuse ?
 The Physical, Emotional/PsychologicalThe Physical, Emotional/Psychological
and Economic Control of Another.and Economic Control of Another.
 Abuse is about Power and Control andAbuse is about Power and Control and
not Love.not Love.

6. Physical AbusePhysical Abuse
 Pushing and ShovingPushing and Shoving
 Pulling HairPulling Hair
 PunchingPunching
 BitingBiting
 Sexual CoercionSexual Coercion

7. Emotional AbuseEmotional Abuse
Belittling/Put DownsBelittling/Put Downs
TauntingTaunting
Threats to Her or Her FamilyThreats to Her or Her Family
Destruction of Things She LovesDestruction of Things She Loves

8. Economic AbuseEconomic Abuse
 Demanding an Accounting of EveryDemanding an Accounting of Every
Penny SpentPenny Spent
 Absolute control over their MoneyAbsolute control over their Money

9. Digital or CyberDigital or Cyber
StalkingStalking
 Teens can be victims of someone whoTeens can be victims of someone who
demands they respond with a picturedemands they respond with a picture
with a clock to prove they are not out withwith a clock to prove they are not out with
someone else.someone else.
 Teen’s parents may not be aware theirTeen’s parents may not be aware their
teen is a victim until they are harmed.teen is a victim until they are harmed.

10. Who Can Be Abused ?Who Can Be Abused ?
 Young or OldYoung or Old
 Male or FemaleMale or Female
 Straight or GayStraight or Gay
 Rich or PoorRich or Poor
 Educated or IlliterateEducated or Illiterate
 Anyone, Anytime, Anywhere,Anyone, Anytime, Anywhere,

11. Violence AgainstViolence Against
WomenWomen
 1 in 5 murders in the U.S. are DV related1 in 5 murders in the U.S. are DV related
 Women abused during pregnancy have aWomen abused during pregnancy have a
threefold increase in risk of beingthreefold increase in risk of being
murderedmurdered
 In the U.S., the percentage of women killedIn the U.S., the percentage of women killed
by an intimate partner rose from 40% toby an intimate partner rose from 40% to
45% over a 10-year period45% over a 10-year period
 Data significantly underestimateData significantly underestimate
prevalence of DVprevalence of DV

12. AssaultAssault
 M Civ JI 115.01 Definition
 An assault is any intentional, unlawful
threat or offer to do bodily injury to
another by force, under circumstances
which create a well-founded fear of
imminent peril, coupled with the apparent
present ability to carry out the act if not
prevented.

13. BatteryBattery
 M Civ JI 115.02 Definition
 A battery is the willful or intentional
touching of a person against that
person’s will [by another / by an object or
substance put in motion by another
person].

14. 95,024 Offenses of DV95,024 Offenses of DV
including Rape wereincluding Rape were
Reported in 2011Reported in 2011
 Michigan Uniform Crime Reports 2011Michigan Uniform Crime Reports 2011

15. Human Costs of AbuseHuman Costs of Abuse
in Michiganin Michigan
 3,290 cases of rape in 20113,290 cases of rape in 2011
 576 children were under 10 years old576 children were under 10 years old
Michigan Uniform Crime Report (2011)Michigan Uniform Crime Report (2011)

16. WHY ?WHY ?
 No single factor explains why one person
and not another behaves in a violent
manner. Violence is a complex problem
rooted in the interaction of many factors
 Biological, Social, Cultural, Economic
and Political,” (WHO, 2002).

17. He Can Stop!He Can Stop!
Past Behavior PredictsPast Behavior Predicts
Future Behavior!Future Behavior!

18. Abuser CharacteristicsAbuser Characteristics
 Charming at firstCharming at first
 Quick CommitmentQuick Commitment
 IsolationIsolation
 Verbal AbuseVerbal Abuse
 ThreatsThreats
 Cruelty to animals and childrenCruelty to animals and children

19. Abuse Is A ChoiceAbuse Is A Choice
 Drugs and Alcohol do not CauseDrugs and Alcohol do not Cause
AbuseAbuse
 Stress does not Cause AbuseStress does not Cause Abuse
 His Partner did not Cause the AbuseHis Partner did not Cause the Abuse
 Abuse is Learned BehaviorAbuse is Learned Behavior
 Abusers, Abuse to get what they WantAbusers, Abuse to get what they Want

20. Characteristics ofCharacteristics of
People in AbusivePeople in Abusive
RelationshipsRelationships
 Traditional Female Roles orTraditional Female Roles or
CharacteristicsCharacteristics
 Low Self-Esteem or Self-BlameLow Self-Esteem or Self-Blame
 Depression or VulnerabilityDepression or Vulnerability
 Lack of Social SupportLack of Social Support

21. Myths of AbuseMyths of Abuse
 He Promised Never to do it AgainHe Promised Never to do it Again
 I Pushed his ButtonsI Pushed his Buttons
 If I am Just Good Enough he will StopIf I am Just Good Enough he will Stop
 I can Help him get BetterI can Help him get Better
 He Would Never Hurt the BabyHe Would Never Hurt the Baby
 It’s My FaultIt’s My Fault

22. Power and ControlPower and Control
WheelWheel

23. Subordination of theSubordination of the
Abused PersonAbused Person
 CultureCulture
 ReligionReligion
 Women Viewed as PropertyWomen Viewed as Property
 Vulnerable ElderlyVulnerable Elderly
 DependentDependent ChildrenChildren
 Vulnerable Mentally IncompetentVulnerable Mentally Incompetent

24. Gorman’s B. S.Gorman’s B. S.
Trajectory ofTrajectory of
ViolenceViolence
 Building--ShoutsBuilding--Shouts
 Bullying--ShovingBullying--Shoving
 Battering--She’s to blameBattering--She’s to blame
 Begging--Sorry, Sorry, SorryBegging--Sorry, Sorry, Sorry
 Believing--Shame--flowers at workBelieving--Shame--flowers at work
 Burying--Suffering has ended--flowersBurying--Suffering has ended--flowers
again; this time for the groundagain; this time for the ground

25. Cultural Barriers toCultural Barriers to
CareCare
 ReligionReligion
 Family NormsFamily Norms
 Traditions of SilenceTraditions of Silence
 The Man is the Head of the HouseholdThe Man is the Head of the Household

26. Structural Barriers toStructural Barriers to
CareCare
 TransportationTransportation
 Economics—Financial DependenceEconomics—Financial Dependence
 Communication—No Phone orCommunication—No Phone or
Computer AccessComputer Access
 Locked in the HouseLocked in the House

27. Domestic Violence Is ADomestic Violence Is A
CrimeCrime
 Majority of states categorize DV as aMajority of states categorize DV as a
misdemeanormisdemeanor
 DV may also be a FelonyDV may also be a Felony

28. Pregnancy IncreasesPregnancy Increases
DVDV
 Abuse often begins in PregnancyAbuse often begins in Pregnancy
 Missed AppointmentsMissed Appointments
 Late or Inadequate Prenatal CareLate or Inadequate Prenatal Care
 LBW and PrematurityLBW and Prematurity
 Homicide is the Leading Cause ofHomicide is the Leading Cause of
Death for Pregnant WomenDeath for Pregnant Women

29. DV During PregnancyDV During Pregnancy
 Most women abused before pregnancy willMost women abused before pregnancy will
be abused during pregnancybe abused during pregnancy
 Abuse may happen for first time duringAbuse may happen for first time during
pregnancypregnancy
 Peaks during the first trimesterPeaks during the first trimester
 Pregnant adolescents are abused at higherPregnant adolescents are abused at higher
rates than are adult womenrates than are adult women
 Risk of fetal injury is highRisk of fetal injury is high

30. Intentional Injury to A PregnantIntentional Injury to A Pregnant
WomanWoman
Is Guilty of A Felony if both A and BIs Guilty of A Felony if both A and B
ApplyApply
 (a)The person intended to cause a miscarriage
or stillbirth by that individual or death or great
bodily harm to the embryo or fetus, or acted in
wanton or willful disregard of the likelihood that
the natural tendency of the person's conduct is
to cause a miscarriage or stillbirth or death or
great bodily harm to the embryo or fetus.
 (b) The person's conduct resulted in a
miscarriage or stillbirth by that individual or
death to the embryo or fetus.

31. Plan and InterventionPlan and Intervention
 ABCDESABCDES of caring for abused womenof caring for abused women
 AloneAlone
 BelieveBelieve
 ConfidentialityConfidentiality
 DocumentationDocumentation
 EducationEducation
 SafetySafety

32. Assessing for DVAssessing for DV
 AWAY FROM HER ABUSERAWAY FROM HER ABUSER
 Every Woman at Every VisitEvery Woman at Every Visit
 Assess the Bathing Suit AreaAssess the Bathing Suit Area
 Document in WritingDocument in Writing
 Photograph injuriesPhotograph injuries
 Inpatients Referred to Social ServicesInpatients Referred to Social Services

33. How to Ask About DVHow to Ask About DV
 Frame the questionsFrame the questions
 We ask all our clients if someone is hurtingWe ask all our clients if someone is hurting
them, someone in their family or close tothem, someone in their family or close to
them. No one has the right to hurt you. I willthem. No one has the right to hurt you. I will
ask you about your relationships, and if youask you about your relationships, and if you
are experiencing violence, we haveare experiencing violence, we have
resources and referrals for you.resources and referrals for you.

34. Three Questions toThree Questions to
AskAsk
 Have you been emotionally or physicallyHave you been emotionally or physically
hurt by someone close to you? Y or Nhurt by someone close to you? Y or N
 Within the last year have you been hit,Within the last year have you been hit,
slapped or otherwise physically hurt byslapped or otherwise physically hurt by
someone? Y or Nsomeone? Y or N
 If yes, by whom and how many times?If yes, by whom and how many times?
 TOTAL______TOTAL______

35. Safety PlanningSafety Planning
 You Don’t Leave Something to go toYou Don’t Leave Something to go to
NothingNothing
 Provide her InformationProvide her Information
 Give her ChoicesGive her Choices
 BELIEVE HERBELIEVE HER
 Document What You DidDocument What You Did
 Document What She SaidDocument What She Said

36. Leaving theLeaving the
RelationshipRelationship
 Leaving is a ProcessLeaving is a Process
 She Needs to Know She can SurviveShe Needs to Know She can Survive
Without HimWithout Him
 The Greatest Danger is when SheThe Greatest Danger is when She
LeavesLeaves
 Only She can Decide When to Leave,Only She can Decide When to Leave,
OR IF TO LEAVE!OR IF TO LEAVE!

37. Care For SexualCare For Sexual
AssaultAssault
 Collaborative careCollaborative care
 Sexual assault examination-Same GenderSexual assault examination-Same Gender
 Preservation of dignity during the examinationPreservation of dignity during the examination
 HistoryHistory
 Collection of evidenceCollection of evidence
 DocumentationDocumentation
 Physical examination and laboratory testsPhysical examination and laboratory tests
 Immediate careImmediate care

38. Prevention is worth aPrevention is worth a
Pound of CurePound of Cure
 Violence against women is a major socialViolence against women is a major social
and health care problemand health care problem
 Thousands of livesThousands of lives
 Billions of dollars in direct and indirect healthBillions of dollars in direct and indirect health
care costscare costs
 DV includes physical, sexual, emotional,DV includes physical, sexual, emotional,
psychological, and economic abusepsychological, and economic abuse

39. Key PointsKey Points
 Cultural influences regarding violentCultural influences regarding violent
behaviors and relationships sensitize thebehaviors and relationships sensitize the
nurse to the special needs of womennurse to the special needs of women
from various ethnic groupsfrom various ethnic groups
 Battering affects young, middle-aged,Battering affects young, middle-aged,
and elderly of all races; alland elderly of all races; all
socioeconomic, educational, religioussocioeconomic, educational, religious
groups, and pregnant womengroups, and pregnant women

40. Key PointsKey Points
 Follow-up and collaborative careFollow-up and collaborative care
important in all instances of abuseimportant in all instances of abuse
 Public Health Providers need to bePublic Health Providers need to be
knowledgeable about reportingknowledgeable about reporting
requirements and available communityrequirements and available community
service for women who have beenservice for women who have been
sexually assaultedsexually assaulted

41. Mandatory ReportingMandatory Reporting
 ChildrenChildren
 ElderlyElderly
 VulnerableVulnerable
 BUT OtherBUT Other Adults Make Their OwnAdults Make Their Own
DecisionsDecisions

42. Reporting Abuse,Reporting Abuse,
NeglectNeglect
If you suspect abuse or neglect, call 855-444-3911 any
time day or night. This toll-free phone number allows you to report abuse or
neglect of any child or adult to the Michigan Department of Human Services.

43. Why Doesn’t SheWhy Doesn’t She
Leave?Leave?
 I will not leave him, because we live withI will not leave him, because we live with
his parents. I have nowhere to go.his parents. I have nowhere to go.
My parents are old and sick. I lost my jobMy parents are old and sick. I lost my job
when they found out I was pregnant.when they found out I was pregnant.
I want to leave, but I do not haveI want to leave, but I do not have papers,papers,
and I do not speak English. Atand I do not speak English. At leastleast
with him, the kids have food,with him, the kids have food, clothesclothes
and a warm bed.and a warm bed.

45. Help Her Make theHelp Her Make the
CallCall
 National Domestic Violence Hotline atNational Domestic Violence Hotline at::
1-800-799-SAFE (7233)1-800-799-SAFE (7233)
or TTY for the Deaf:or TTY for the Deaf:
1-800-787-32241-800-787-3224
 www.ndvh.orgwww.ndvh.org
 www.michigan.gov/domesticviolencewww.michigan.gov/domesticviolence

46.  Abuse should never be fashionableAbuse should never be fashionable
Questions?Questions?