4,000 women die each year in the US as a result of battery 40-60% of female homicide victims are killed by their intimate partners Domestic Violence is the number one reason women in the reproductive age group are hurt in the US

25% of female suicide attempts* 23% of women seeking prenatal care 25-35% of women seen in ERs 60% of mothers of abused children 14% of women in internal medicine clinics Our mothers, our sisters, our daughters and our friends Are all ages and from all socioeconomic, ethnic, religious and educational groups *Stark, Evan, and Filtcraft, 1996 Battered Women are…

Only about 1 in 20 patients that are victims of DV are recognized as such by their doctors

Our patients provide their own barriers We worry about offending our patients We don ’ t have time We have our own hang ups We don ’ t know what to do if she says “ yes ” We really don ’ t believe that we make a difference We do not know the frequency or impact of DV on our patient’s lives

We Don ’ t Ask!

Universal Screening JUSTIFIED! An educational tool Removes prejudice and misconceptions Should be on Health care screen and again face to face Should be private Keep it simple Don ’ t forget to screen men, lesbians, the elderly

Universal Screening Opportunities  Every patient seen in the ER  First Prenatal Visit & Postpartum Risk of violence and serious injury increases during pregnancy and postpartum  Admission to the Hospital  During routine annual examination  Upon noticing any injury or unusual interaction between the couple

Findings and Clues  Substance abuse  Depression and anxiety  Sexually transmitted diseases  Miscarriage and stillbirth  Decreased fetal movement  Pain during ultrasound Inappropriate use of the ER Unusual interactions during counseling Preterm contractions Preterm delivery  12% of births in the US  Related to DV?? Vaginal bleeding  Placental abruption

Pregnancy provides opportunities…  Easier to establish good communication with patient  Frequent visits  Increased counseling  Nursing involvement in L&D and post partum  Patient more motivated to seek help

One in six neonates will go home to a violent home

CA State Law AB 1652 …every health practitioner employed in any health care facility who has knowledge of or observes a patient whom he/she suspects is suffering from a wound or injury which is the result of abusive conduct to make a report to local law enforcement by 1.Phone immediately 2.Written report within 2 working days

Reporting is not enough…  Safety assessment How serious is the threat or injury? Lethality prediction is iffy… Is there someone else in the house? What about child abuse? What about depression, suicide risk? Is there a gun in the house? Where can she go? Should she be admitted to the hospital?

You are not alone  Call your local shelter  Consider women ’ s support groups  Human Options-Irvine  Interval House-Santa Ana  Laura ’ s House- San Clemente  Women ’ s Transitional Living Center- Fullerton   Carolina Harris