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Domestic
Violence
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Specific
references to child or elder abuse are not included in today's
Resource Note (RN), as they will be addressed individually
in future Notes.
As I was beginning
to pull together sources for today's Note, the new booklet
describing the Center for Outcomes Research and Education
(CORE) in the Department of Occupational Therapy at the University
of Illinois in Chicago (UIC) was dropped on my desk.
In it, I found a description about the work of Christine Helfrich,
PhD, OTR on domestic violence. With funding
from NIDRR, Dr. Helfrich is " . . . examining how domestic
violence impacts occupational functioning through three interrelated
investigations that will document functional problems and
identify the need for services among women who are domestic
violence victims." There is also a brief mention of
a coming paper in which she " . . . compares women who are
victims of domestic violence with a national sample demonstrating
that the former experience more mental health problems that
interfere with their ability to work, attend school and carry
out daily living tasks." Dr. Helfrich hopes to use the
results of her studies to show the effectiveness of occupational
therapy intervention with the victims of domestic violence.
Finally, She and several collaborators authored the 2001 book
Domestic violence across the lifespan: The role of occupational
therapy, published by Haworth Press, Inc. It is volume
16, Numbers 2 and three of the periodical Occupational
Therapy in Mental Health. Unfortunately, I discovered
that the library's copy has not arrived.
Following are resources,
printed and electronic on domestic violence.
References:
1.Beatt, R.M.
(2000). Health professionals' knowledge of women's
health care. Journal of Continuing Education
in Nursing, 31(6), 275-9.
ABSTRACT: Until
1986, the only issues in women's health which received direct
attention were those related to childbearing. At that time
the National Institutes of Health made inclusion of women
in research a criteria for funding. Since then, the knowledge
base to guide disease prevention and treatment of women has
grown dramatically. Unfortunately, the incorporation of these
data into clinical practice has been much slower. The purpose
of this needs assessment was to establish a comprehensive
database on which future programming decisions could be based.
Areas of interest identified by health care providers included
stress reduction, breast health, prevention of heart disease,
and osteoporosis. Other topics that emerged were menopause
and reproduction issues, cancer prevention, domestic violence,
substance abuse, nutrition, and weight control. These data
suggest topics for future programming.
ABSTRACT: Objectives:
To determine exposure to violence by a partner or spouse among
women attending general practice and its association with
respondents' demographic and personal characteristics; frequency
of inquiry about violence by general practitioners; and women's
views on routine questioning about domestic violence by general
practitioners. Design: Cross sectional, self administered,
anonymous survey. Setting: 22 volunteer Irish general practices.
Participants: 1871 women attending general practice. Main
outcome measures: Proportion who had experienced domestic
violence, severity of such violence, and context in which
violence occurred. Results: Of the 1692 women who had ever
had a sexual relationship, 651 (39%, 95% confidence interval
36% to 41%) had experienced violent behaviour by a partner.
78/651 (12%) women reported that their doctor had asked about
domestic violence. 298/651 (46%, 42% to 50%) women had been
injured, 60 (20%) of whom reported that their doctor had asked
about domestic violence. 1304/1692 (77%, 77% to 80%) were
in favour of routine inquiry about domestic violence by their
usual general practitioner. 1170 women (69%) reported controlling
behaviour by their partner and 475 (28%) reported feeling
afraid of their previous or current partner. Women who reported
domestic violence were 32 times more likely to be afraid of
their partner than women who did not report such violence.
Conclusions: Almost two fifths of women had experienced domestic
violence but few recalled being asked about it. Most women
favoured routine questioning by their practitioner about such
violence. Asking women about fear of their partner and controlling
behaviour may be a useful way of identifying those who have
experienced domestic violence. Retrieve Full-text:
3.Dubnova, I.
& Joss, D.M. (1997). Women and domestic
violence: global dimensions, health consequences and intervention
strategies. Work: A Journal of Prevention, Assessment
& Rehabilitation, 9(1), 79-88.
ABSTRACT: Domestic violence against women is a significant
health and social problem affecting virtually all societies.
The sensitivities and stigma associated with domestic violence,
the conceptualization of it primarily as a judicial and legal
issue, and the lack of data on the dimensions of abuse have
hampered understanding and the development of appropriate
interventions. Secrecy, insufficient evidence, and social
and legal barriers continue to make it difficult to acquire
data on domestic violence against women. This paper
describes the magnitude and health consequences of domestic
violence. It explores factors that perpetuate violence
against women, and discusses intervention strategies from
around the world.
4.Elliott, L.,
Nerney, M., Jones, T. & Friedmann, P.D. (2002).
Barriers to screening for domestic violence. Journal
of General Internal Medicine, 17(2), 112-6.
ABSTRACT: CONTEXT:
Domestic violence has an estimated 30% lifetime prevalence
among women, yet physicians detect as few as 1 in 20 victims
of abuse. OBJECTIVE: To identify factors associated
with physicians' low screening rates for domestic violence
and perceived barriers to screening. DESIGN: Cross-sectional
postal survey. PARTICIPANTS: A national systematic sample
of 2,400 physicians in 4 specialties likely to initially encounter
abused women. The overall response rate was 53%. MAIN
OUTCOME MEASURE: Self-reported percentage of female patients
screened for domestic violence; logistic models identified
factors associated with screening less than 10%. RESULTS:
Respondent physicians screened a median of only 10% (interquartile
range, 2 to 25) of female patients. Ten percent reported they
never screen for domestic violence; only 6% screen all their
patients. Higher screening rates were associated with
obstetrics-gynecology specialty (odds ratio [OR], 0.49; 95%
confidence interval [CI], 0.31 to 0.78), female gender (OR,
0.51; CI, 0.35 to 0.73), estimated prevalence of domestic
violence in the physician's practice (per 10%, OR, 0.72; CI,
0.65 to 0.80), domestic violence training in the last 12 months
(OR, 0.46; CI, 0.29 to 0.74) or previously (OR, 0.54; CI,
0.34 to 0.85), and confidence in one's ability to recognize
victims (per Likert-scale point, OR, 0.71; CI, 0.58 to 0.87).
Lower screening rates were associated with emergency medicine
specialty (OR, 1.72; CI, 1.13 to 2.63), agreement that patients
would volunteer a history of abuse (per Likert-scale point,
OR, 1.60; CI, 1.25 to 2.05), and forgetting to ask about domestic
violence (OR, 1.69; CI, 1.42 to 2.02). CONCLUSIONS: Physicians
screen few female patients for domestic violence. Further
study should address whether domestic violence training can
correct misperceptions and improve physician self-confidence
in caring for victims and whether the use of specific intervention
strategies can enhance screening rates.
5.Fulton, D.R.
(2000). Recognition and documentation of domestic
violence in the clinical setting Critical Care Nursing
Quarterly, 23(2), 26-34.
ABSTRACT: Critical
care nurses may encounter a victim of domestic violence or
abuse when caring for an individual with traumatic injuries.
Understanding the injuries that are associated with acts of
violence is only the first step. A vital part of the nurse's
responsibilities is the precise written documentation of observations,
physical assessments, and other factors that may later become
vital evidence in a court of law.
6.Helfrich, C.
(1997). Domestic violence abuse: Perspectives
for OT Educators and practitioners. In: The American Occupational
Therapy Association. (1997). Conference Abstracts
and Resources. Bethesda, MD: Author, (pp. 189-190
ABSTRACT: Domestic violence is an international act of physically
or emotionally harming another person related by blood, marriage,
having a common child or a dating relationship. This
includes a person with a disability and their personal assistant.
Domestic violence kills over 3,650 women each year and accounts
for more injuries than rapes, muggings and automobile accidents
combined (Loseke, 1992). Occupational therapists treat
women and children with a wide variety of physical and emotional
injuries. Many victims will not readily disclose the
violence; instead they create fictitious causes for their
injuries. Children who have experienced various types
of maltreatment suffer from neglect, sexually, physical and
emotional abuse. It is important to identify a domestic
violence survivor to administer treatment appropriately.
Contact with survivors of domestic violence can raise many
issues with therapists such as denial, guilt, memories of
one's own history of abuse, blame, anger and fear. Most
curricula do not include material on the effects and treatment
of victims of violence (Qalens, Dickie, Tomlinson, Raynor,
Wittman & Kannenberg, 1995). Therapists must be
aware of their own attitudes about domestic violence, issues
which arise for them during treatment and factual information
regarding the cycle of violence in order to be therapeutic
(Davis, 1994). The cycle of violence includes: 1) Tension
phase which includes arguing, blaming and anger, 2) Battering
phase which includes slapping, choking, sexual abuse, threats
and use of weapons, 3) Calm Stage which includes denial, gifts,
and other tokens of making up. The calm stage decreases
over time as the violence increases.
Occupational therapists
can be most effective during battering phase when the woman's
defenses are decreased and she wants help. She may fear
for her life or the safety of her children. At this
time referrals to social work, shelters for battered women
& children and helping the interdisciplinary team understand
the psychosocial issues she is enduring are important.
The solutions to ending domestic violence are complicated.
Many different disciplines, the police, and the justice system
all need to be involved; however, a common factor is education.
Education about domestic violence is needed to decrease myths
and increase understanding of reality and one's own beliefs.
The media has added to the stigma of domestic violence in
recent years through movies, news reports and television.
If occupational therapists are to contribute to ending the
epidemic of domestic violence we must begin discussing these
issues openly in the classroom, on fieldwork and in work settings.
It is not possible to absorb the factual and emotional information
about abuse in one session. The information needs to
be understood and integrated gradually; therefore educators
and clinicians need assist students and colleagues in this
process.
7.Helton, S.M.
& Evans, G.W. (2001). "She looked just like
me." A domestic violence learning module.
Issues Mental Health Nursing, 22(5), 503-16.
ABSTRACT: This
paper describes a 22-hour domestic violence learning module
that is incorporated into the psychosocial course for seniors
in a baccalaureate nursing program. As part of their learning
experiences, students attend circuit court, meet with judges,
and accompany advocacy workers. Additionally, they attend
group therapy sessions with both the victims and perpetrators
of abuse. Students keep journals reflecting their thoughts,
feelings, and reactions throughout the experiences. Thematic
analysis of these journal entries revealed five common themes.
Students recognized their encounters in clinical situations
as frightening and emotionally difficult, expressed surprise
at their reactions to perpetrators, identified with victims,
wrestled with issues of good and bad, and reported that stereotypes
about victims and perpetrators had been incorrect. Debriefings
and support by faculty are important for students throughout
the experience.
8.Jewkes, R.
(2002). Preventing domestic violence. BMJ,
324(7332), 253-4.
9.Merrell, J.
(2001). Social support for victims of domestic violence.
Journal of Psychosocial Nursing & Mental Health Services,
39(11), 30-5, 46-7.
ABSTRACT: Nurses in a variety of settings encounter
people whose lives are affected by domestic violence. Case
identification, crisis intervention, advocacy, psychoeducation,
psychotherapy, case management, and referral networking
are tasks that can be performed by nurses with various levels
of education. A holistic approach is needed when caring
for victims, perpetrators, and witnesses of physical and
psychological violence. A variety of disciplines must work
together to challenge this multifaceted social dilemma.
Nurses can guide clients to useful resources to help battle
the tide of violence existing in society today.
10.Richardson,
J., Coid, J., Petruckevitch, A., Chung, W.S., Moorey,
S. & Feder, G. (2002).
Identifying domestic violence: cross sectional study in
primary care. BMJ, 324(7332), 274.
ABSTRACT:
Objectives: To measure the prevalence of domestic violence
among women attending general practice; test the association
between experience of domestic violence and demographic factors;
evaluate the extent of recording of domestic violence in records
held by general practices; and assess acceptability to women
of screening for domestic violence by general practitioners
or practice nurses. Design: Self administered questionnaire
survey. Review of medical records. Setting: General
practices in Hackney, London. Participants: 1207 women (>15
years) attending selected practices. Main outcome measures:
Prevalence of domestic violence against women. Association
between demographic factors and domestic violence reported
in questionnaire. Comparison of recording of domestic violence
in medical records with that reported in questionnaire. Attitudes
of women towards being questioned about domestic violence
by general practitioners or practice nurses. Results: 425/1035
women (41%, 95% confidence interval 38% to 44%) had ever experienced
physical violence from a partner or former
partner and 160/949
(17%, 14% to 19%) had experienced it within the past year.
Pregnancy in the past year was associated with an increased
risk of current violence (adjusted odds ratio 2.11, 1.39 to
3.19). Physical violence was recorded in the medical records
of 15/90 (17%) women who reported it on the questionnaire.
At least 202/1010 (20%) women objected to screening for domestic
violence. Conclusions: With the high prevalence of domestic
violence, health professionals should maintain a high level
of awareness of the possibility of domestic violence, especially
affecting pregnant women, but the case for screening is not
yet convincing.
11.Schmerzler,
A.J., Goldstein, J. & Parkin, K. (2001).
Women, spinal cord injury, and domestic violence: A review.
Topics in Spinal Cord Injury Rehabilitation, 7(1),
37-41.
ABSTRACT:
Women represent an underreported segment of the spinal cord
injury (SCI) community. A majority of the literature written
on SCI deals with its impact from the male point of view.
Very few articles acknowledge or address the social problems
that women with SCI encounter. This article will address
the specific social issue of domestic violence and will offer
a number of recommendations for the rehabilitation community.
12.Sethi D.,
Watts S., Watson J., McCarthy C. & Zwi A. (2001).
Experience of 'screening' for domestic violence in women's
services. Journal of Public Health Medicine,
23(4), 349-50.
13.Stancliff,
B.L. (1997). Invisible victims. OT
Practice, 2(10), 18-21,23-28.
14.Taft, A.,
Hegarty, K. & Flood, M. (2001). Are men and women equally
violent to intimate partners? Australian New Zealand
Journal of Public Health, 25(6), 498-500.
ABSTRACT: Violence
against women is a significant public health issue. One form
of violence against women, intimate partner abuse or domestic
violence, is prevalent in Australia. In this article, we summarise
the main theoretical and methodological debates informing
prevalence research in this area. We explain why studies finding
equivalent victimisation and perpetration rates between the
sexes are conceptually and methodologically flawed and why
coercion and control are fundamental to the definition and
measurement of partner abuse. We conclude that while male
victims of partner abuse certainly exist, male victims of
other forms of male violence are more prevalent. A focus on
gendered risk of violence in public health policy should target
male-to-male public violence and male-to-female intimate partner
abuse.
15.U. S. Department
of Agriculture, Safety, Health and Employee Welfare
Division.
"Domestic
violence awareness handbook"
16.Yeager, K.
& Seid A. (2002). Primary care and
victims of domestic violence. Primary Care, 29(1),
125-50.
ABSTRACT: Providing
quality health care involves integrating routine inquiry about
domestic violence into ongoing clinical practice. This means
asking all women patients, and others who may be at risk,
about abuse in their lives. Whether or not a woman chooses
to use services or leave her partner, our intervention is
very important. Some women return to violent partners several
times before they feel safe enough to leave, feel they can
survive on their own, or can accept that the person they love
will not change. Make sure that she has follow-up for her
medical problems and appropriate referrals for mental health
and substance abuse problems when indicated.
On-Line
Resources:
Statistics:
American
Bar Association, Commission on Domestic Violence,
American College of Obstetricians and Gynecologists, "Interpersonal
violence against women throughout the life span"
U. S. Department of Justice, Bureau of Justice Statistics,
" Violence
rates among intimate partners differ greatly according to
age"
Organizations
and Phone Numbers:
American Bar Association, Commission on Domestic Violence,
"Important
Phone Numbers"
National
Coalition against Domestic Violence
"State
Coalition List"
National
Domestic Violence Hotline
1-800-799-SAFE
(7233) 1-800-787-3224 (TDD)
National
Network to End Domestic Violence
Compiled by Mary
Binderman, MLS, Director of Information Resources, The American
Occupational Therapy Foundation, Bethesda, MD.
March 8, 2002
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