Academy on Violence & Abuse 2011 Perpetration of IPV: Translating research into curriculum Robin Mason, PhD Contact:

Objectives By the end of this session participants will: 1.Recognize perpetrator indicators for IPV 2.Learn a process for turning research knowledge into a meaningful curriculum 3.Engage with the interactive curriculum

The Process We built on a competency-based online curriculum originally developed for emergency department settings (funded by the province of Ontario) Goal: to increase curriculum’s relevance for family physicians Discussions with family physicians to determine key issues in their practice. They said: oongoing non-lethal violence; ored flags for lethal violence & what to do in such cases; opractices when both partners are patients

The Process cont’d Literature review oLack of guidelines on family physicians’ responsibility when there are “red flags” suggestive of potential lethal violence in either scientific or grey literature Assembled an Expert Panel (family physicians and DV experts) Due to lack of guidelines, we consulted: Domestic Violence Death Review Committee of the Coroner’s Office (DVDRC), police DV team, Ontario College of Family Physicians, the hospital’s lawyer, other DV experts Competencies determined; Scenarios developed; Advertising campaign designed

Perpetrators & Family Physicians 7% of men in relationships reported physically hurting their partner in the past year; 16% in their lifetimes 97% of perpetrators (and victims) believe family physicians should ask about DV 93% believe their physicians could be helpful (Burge et al., 2005) Family physicians have difficulty managing dual relationships (Ferris et al., 1999; Taft et al., 2004)

Risk Factors: Perpetration of IPV Key risk factors include: osubstance abuse ohis growing up with violence and substance abuse ohis low level of education and income ohis belief that violence against women is acceptable ohis belief that alcohol or drugs makes people violent (Bennett, 1998)

A case study of 11-US cities found perpetrators are more likely to have: o Not-graduated from high school o Substance use problems o Fair or poor mental health o A history of threatened or actual pet abuse (Campbell, 2005) In addition: oYounger age oCommon-law, separated or divorced oPerceptions of poor mental health oChildhood experiences of family violence oChronic unemployment oCriminal behaviour (Walton-Moss, et al. 2005) Risk Factors: Perpetration of IPV

IPV and Femicide On average 60 Canadian women are murdered by their current or former partner every year Ont women were killed by partners (DVDRC 2008) In 8 out of 9 cases, the murder was both predictable and preventable* (DVDRC 2005). 85% of femicide or attempted femicide victims experienced prior IPV (including stalking) BUT almost half of femicide victims did not have a history of prior physical or sexual abuse (Campbell et. al, 2003)

Victims (Ontario 2010) Stephanie Hoddinott age 20 Ashley Boudreau age 24, Name withheld age 48 Michelle Quemener age 46 Marie Roberts age 29 Lorena Sousa age 36 Bryce Smith age 3 mths, Hinda Tannous age 64 Marion Deacon age 46 Tracy Hannah age 46 - her daughter Whitney Hannah age 14 Kayleigh Ingram-Summers age 4 months Carol Ann Brunet age 54 Charmaine Whitley age 38 Ayan Osman age 28 Name withheld age 24 Sereena Denesiuk age 26 Jocelyn Amber Bishop age 21 Aster Kassa age 32 Anne Julien-Guerin age 48 Joanne Cooke age 36 Adrienne Roberts age 33 Wanda Taylor age 44

Risk Factors: Perpetration of Femicide Less research Identified risk factors include: oSeparation oPast IPV oObsessive behaviour and jealousy (stalking, harassment) oDepression oNew partner on the scene oEscalation of violence oPast threats to kill the victim Based on Ontario data, the next most significant risk factor is perpetrator’s excessive alcohol or drug use (DVDRC 2008).

DVDRC Top 10 Risk Factors (5-Year) 1. Actual or pending separation (79%) 2. History of domestic violence (75%) 3. Perpetrator depressed* (63%) 4. Perpetrator ’ s obsessive behaviour (63%) 5. Escalation of violence (50%) 6. Prior threats to kill victim (45%) 7. Prior threats to commit suicide (44%) 8. Prior attempts to isolate victim (44%) 9. Access to/possession of firearms (42%) 10 Excessive alcohol or drug use (40%) * Not clinically diagnosed

Multiple Risk Factors in Most Femicides Actual or pending separation History of domestic violence Obsessive behaviour displayed by perpetrator Perpetrator depressed Escalation of violence Prior threats to kill victim Prior threats/attempts to commit suicide History of violence outside the family Prior attempts to isolate victim Victim had intuitive sense of fear Excessive alcohol and/or drug use Access to or possession of firearms Control of most or all of victim’s daily activities Perpetrator unemployed An actual or perceived new partner in victim’s life

Femicide Followed By Suicide Approximately 25% of femicides are followed by suicide (compared with 5% in non intimate homicides)

Risk Factors: Femicide-Suicide Access to a gun Prior IPV occurred in half of cases Prior threats to murder her or kill self Depression Middle aged (usually older than partner) Married (or long term common-law or live-in relationship) Employed Jealousy, separation, woman having a new partner were frequent triggers

Domestic Violence Death Review Committee Recommendation # “ It is recommended that healthcare providers be taught to be mindful of the dynamics of domestic violence and the potential for lethality, especially when working with patients who have a history of drug abuse, depression, anxiety, and suicidal ideation, particularly when there is high conflict in their marriage and a history of numerous separations. ”